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Report #2867165

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
Female
Age
81 yrs
State
IA
Recovered
Unknown
Vaccinated
Apr 11, 2025
Onset
Oct 20, 2025
Days to onset
192
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13046731IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, ESSENTIAL (PRIMARY) HYPERTENSION, ABDOMINAL AORTIC ANEURYSM, WITHOUT RUPTURE, UNSPECIFIED, UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, INTRADUCTAL CARCINOMA IN SITU OF RIGHT BREAST, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, HYPERLIPIDEMIA, VITAMIN D DEFICIENCY, UNSPECIFIED

Other medications

Myrbetriq, Tramadol, acetaminophen, Vitamin D3, Ventolin inhaler, Flutic/Salme inhaler, Tums ultra, Losartan, Amlodipine, Metoprolol, Pantoprazole, Bacitracin ointment, Hydralazine, Potassium Chloride, Anastrozole, Levothyroxine, Guaifenes

Allergies

No known allergies