Report #2869302

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: 81 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 24, 2025
Onset: Oct 28, 2025
Days to onset: 187
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3046731	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS, DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, VITAMIN D DEFICIENCY, UNSPECIFIED, ESSENTIAL (PRIMARY) HYPERTENSION, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, CHRONIC KIDNEY DISEASE, STAGE 3A

Other medications

Ipratropium-Albuterol solution, Tamsulosin, Sertraline, Antacid, Combivent inhaler, Vitamin D3, Carbidopa-Levodopa, Finasteride, Polyethylene Powder, Quetiapine Fumarate, Atenolol, Melatonin, Acetaminophen, Tramadol,

Allergies

Covid -19 vaccine, Haloperidol, Mirtazapine, Simvastatin