Report #2875696

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: 76 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 10, 2025
Onset: Nov 28, 2025
Days to onset: 49
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

DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, ALZHEIMER'S DISEASE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, HYPERLIPIDEMIA, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, DYSPHAGIA, ANISOCORIA

Other medications

Acetaminophen, Polyethylene powder, Fluoxetine, Buspirone, Ipratropium- Albuterol Inhalation solution, Trazodone, Guaifenesin

Allergies

No known allergeries