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Report #2869301

Received Oct 29, 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
86 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 8, 2025
Onset
Oct 29, 2025
Days to onset
21
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA18146367IM / LA

Symptoms (1)

Death

Symptom narrative

Resident expired

Medical history

UNSPECIFIED DEMENTIA,PERSONAL HISTORY OF (HEALED) TRAUMATIC FRACTURE,ATRIAL FIBRILLATION,VITAMIN D DEFICIENCY,UNSPECIFIED MOOD [AFFECTIVE] DISORDER, BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS, HYPERLIPIDEMIA,ESSENTIAL (PRIMARY) HYPERTENSION,ATRIAL FIBRILLATION,TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS

Other medications

Atorvastatin Calcium, Jardiance, Polyethylene Glycol, Quetiapine Fumarate, Tamsulosin HCL, D3, Divalproex Sodium, Eliquis, Memantine HCL, Acetaminophen

Allergies

Memantine, Tamsulosin, Donepezil