Report #2857239

Received Sep 8, 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: 83 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 10, 2025
Onset: Sep 6, 2025
Days to onset: 149
Hospital days: —

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

SCHIZOPHRENIA, UNSPECIFIED, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, ALZHEIMER'S DISEASE WITH LATE ONSET, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE,

Other medications

Tums, Polyethylene powder, acetaminophen, Donepezil, risperidone, guaifenesin, antacid, melatonin, dairy relief, senexon-s, simethicone, Albuterol inhaler, sucralfate, clonazepam, therapeutic shampoo, omeprazole, clonidine,

Allergies

Tetracycline, Penicillin's