Report #2865478

Received Oct 13, 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: 87 yrs
State: IA
Recovered: Unknown
Vaccinated: Jul 2, 2025
Onset: Oct 11, 2025
Days to onset: 101
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3046732	IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

HYPERLIPIDEMIA, MAJOR DEPRESSIVE DISORDER, RECURRENT, IN FULL REMISSION, ANXIETY DISORDER, PAROXYSMAL ATRIAL FIBRILLATION, DYSTHYMIC DISORDER, PERSONAL HISTORY OF OTHER VENOUS THROMBOSIS AND EMBOLISM, PERSONAL HISTORY OF MALIGNANT NEOPLASM OF PROSTATE, ESSENTIAL (PRIMARY) HYPERTENSION

Other medications

furosemide, mirtazapine, sertraline, Eliquis, polyethylene powder, acetaminophen, metoprolol, melatonin, finasteride, tamsulosin, potassium chloride, hydroxyzine,

Allergies

No known allergies