Report #2866952

Received Oct 20, 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: 92 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 14, 2025
Onset: Oct 19, 2025
Days to onset: 5
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052671	IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED, PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS, MALIGNANT NEOPLASM OF PROSTATE, VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL), HEREDITARY LYMPHEDEMA, MONOCLONAL GAMMOPATHY

Other medications

Valproic Acid solution, polyethylene powder, Acetaminophen, Cefdinir, Eliquis, Galantamine Hydrobromide, Senna, Docusate, Preservision AREDS, quetiapine, Mirtazapine, Bisacodyl suppository, furosemide, guaifenesin,

Allergies

Haloperidol, Sertraline