Report #2853571

Received Aug 11, 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: Female
Age: 97 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 17, 2024
Onset: Aug 9, 2025
Days to onset: 296
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3043159	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, ATRIAL FIBRILLATION, HYPOTHYROIDISM, TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA, HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

Other medications

Eliquis, Thera-M Tab, Furosemide, Diltiazem, Levothyroxine, Refresh eye drop, Glipizide, Metoprolol, Oyst Shell/D, cough drops, Acetaminophen, Melatonin, Tresiba

Allergies

Lisinopril