Report #2853781

Received Aug 12, 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: 94 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 23, 2025
Onset: Aug 12, 2025
Days to onset: 111
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3046731	IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

DEMENTIA, PULMONARY HYPERTENSION, VITAMIN D DEFICIENCY, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, IRON DEFICIENCY ANEMIA, CHRONIC ATRIAL FIBRILLATION, HYPOTHYROIDISM, MALIGNANT MELANOMA OF SKIN, UNSPECIFIED, NONRHEUMATIC MITRAL (VALVE)

Other medications

Carvedilol, Acetaminophen, Lovastatin, Levothyroxine, Vitamin D3, Eliquis, Melatonin, Diclofenac gel, Robafen DM oral liquid

Allergies

No known Allergies