Report #2852648

Received Aug 4, 2025

Died

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 84 yrs
State: IA
Recovered: Unknown
Vaccinated: Jan 17, 2025
Onset: Aug 2, 2025
Days to onset: 197
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3044202	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

CHRONIC OBSTRUCTIVE PULMONARY DISEASE, TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, SEIZURES, HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITH HEART FAILURE AND STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE , GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, MALIGNANT NEOPLASM OF LOWER LOBE, LEFT BRONCHUS OR LUNG, VITAMIN D DEFICIENCY, HYPERTENSION

Other medications

Resident admitted with these medications to our facility on 4/8/2025---Ondansetron, Famotidine, Polyethylene Powder, Bisacodyl suppository, Docusate Sodium, Vitamin D3, Pantoprazole, Humalog insulin, Milk of Magnesia, Gabapentin, Refresh ey

Allergies

Amoxicillin, Codeine, Augmentin