Report #2875690

Received Dec 1, 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: Nov 7, 2025
Onset: Nov 28, 2025
Days to onset: 21
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	8146751	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE, EMPHYSEMA, MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, HYPOMAGNESEMIA, INFRARENAL ABDOMINAL AORTIC ANEURYSM, WITHOUT RUPTURE, PLEURAL EFFUSION, NOT ELSEWHERE CLASSIFIED, ALCOHOLIC HEPATITIS WITHOUT ASCITES, ATHEROSCLEROSIS OF NATIVE ARTERIES OF EXTREMITIES WITH INTERMITTENT CLAUDICATION, BILATERAL LEGS, ESSENTIAL (PRIMARY) HYPERTENSION, PERIPHERAL VASCULAR DISEASE, UNSPECIFIED ATRIAL FIBRILLATION

Other medications

Furosemide, Pregabalin, Stiolto Respimat inhalation, Senexon-S, Refresh eye drops, Fish oil Omega-3, guaifenesin, acetaminophen, Finasteride, Levothyroxine, Amiodarone, Oxycodone-acetaminophen, Diclofenac sodium gel, Cyclobenzaprine, Thera-

Allergies

Carbamazepine, Spironolactone,