Report #2867514

Received Oct 21, 2025

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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: 70 yrs
State: GA
Recovered: Not recovered
Vaccinated: Oct 15, 2025
Onset: —
Days to onset: —
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	UNK	3048034	IM / RA
FLU3	INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)	SANOFI PASTEUR	UNK	UT8829BA	IM / LA

Symptoms (1)

Death

Symptom narrative

Unknown if associate, but Pt died 10/16/2025.

Current illness

None Known

Medical history

HTN, Mood disorder, HLD, MASLD, T2DM, Reflux, Ucler D7, BPH, Arthritis

Other medications

Amlodipine 10 mg, Fexofenadine 180 mg, Fluticasone Propionate 50 mcg, Furosemide 20 mg, Gabapentin 300 mg, Lamotrigine 200 mg, Losartan 100 mg, Lovastatin 40 mg, Metformin 1,000 mg, Metoprolol Succinate ER 50 mg, Mometasone 0.1% topical cre

Allergies

PCN

Lab data

None