Report #2853578

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: Male
Age: 81 yrs
State: IA
Recovered: Unknown
Vaccinated: Nov 22, 2022
Onset: Aug 11, 2025
Days to onset: 993
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	23H22A	IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

UNSPECIFIED DEMENTIA, MILD, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, MIXED HYPERLIPIDEMIA, MALIGNANT NEOPLASM OF PROSTATE, TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED, ESSENTIAL (PRIMARY) HYPERTENSION, POST-TRAUMATIC STRESS DISORDER, UNSPECIFIED, HYPOMAGNESEMIA, IRON DEFICIENCY ANEMIA, PURE HYPERCHOLESTEROLEMIA

Other medications

Resident admitted to our facility on 7/8/2025 with the following medication: Escitalopram, Gvoke PFS, Milk of Magnesia, Lisinopril-hydrochlorothiazide, Famotidine, Tamsulosin, Magnesium Oxide, Hydrocodone-Acetaminophen, Lactobacillus, Bisac

Allergies

Codeine