Report #2857561

Received Sep 9, 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: Oct 26, 2023
Onset: Sep 8, 2025
Days to onset: 683
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3032233	IM / RA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

TYPE 2 DIABETES MELLITUS WITH DIABETIC POLYNEUROPATHY, ESSENTIAL (PRIMARY) HYPERTENSION, PRIMARY OPEN-ANGLE GLAUCOMA, MYOGENIC PTOSIS OF BILATERAL EYELIDS, NONEXUDATIVE AGE-RELATED MACULAR DEGENERATION,

Other medications

Latanoprost, Duloxetine, Fluticasone nasal spray, artificial tears, glipizide, hemorrhoidal ointment, polyethylene powder, Bisacodyl supp, Tamsulosin, Dorzol/Timol eye solution, Diclofenac gel, gabapentin, metformin, acidophilus chew, finas

Allergies

Penicillin