Report #2857572

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: 79 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 29, 2025
Onset: Sep 8, 2025
Days to onset: 132
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

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE,, UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE, CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED, HYPOKALEMIA, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS,

Other medications

Thera-tabs , Potassium, Tresiba insulin, Eliquis, Metformin, Fluticasone, Fluoxetine, Furosemide, Donepezil, Jardiance, Brimonidine eye drops, Fish oil, latanoprost eye drop, Dorzolamide eye drop, Anti- Diarrheal, Acetaminophen, Miconazol

Allergies

Sulfa Antibiotics