Report #2868763

Received Oct 27, 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: 77 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 10, 2025
Onset: Oct 27, 2025
Days to onset: 17
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	8146367	IM / RA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS, HALLUCINATIONS, UNSPECIFIED, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, HYPERLIPIDEMIA, UNSPECIFIED, DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, ESSENTIAL (PRIMARY) HYPERTENSION, CHRONIC KIDNEY DISEASE, UNSPECIFIED

Other medications

Multivitamin, Myrbetriq, Donepezil, acetaminophen, Metamucil powder, Polyethylene powder, Senna, Ketoconazole shampoo, prevident toothpaste, Vicks vapor rub, Mirtazapine, guaifenesin, amlodipine, Stye ointment, Alendronate, Ventolin inhal

Allergies

Haloperidol, Hydrocodone, oxycodone, Penicillin