Report #2871880

Received Nov 10, 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: 80 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 10, 2024
Onset: Nov 10, 2025
Days to onset: 396
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3043159	IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

SCHIZOAFFECTIVE DISORDER, UNSPECIFIED, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, OTHER SPECIFIED DISEASES OF LIVER, HYPERLIPIDEMIA, PERSONALITY DISORDER, OBSESSIVE-COMPULSIVE DISORDER, UNILATERAL INGUINAL HERNIA, WITHOUT OBSTRUCTION OR GANGRENE, RECURRENT,

Other medications

Risperidone, Acetaminophen, Systane eye drops, Simvastatin, Vitamin D3, Nice lozenge, pain relieving cream, AloeVistaProt. Ot Triamcinolone cream, Senna, Aripiprazole, Desonide cream, aspirin, Trazadone, Hydrocodone- Acetaminophen,

Allergies

Clonazepam, Klonopin