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Report #2876165

Received Dec 3, 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
Female
Age
83 yrs
State
IA
Recovered
Unknown
Vaccinated
Oct 17, 2024
Onset
Dec 2, 2025
Days to onset
411
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13043159IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

END STAGE RENAL DISEASE , DEPENDENCE ON RENAL DIALYSIS, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, HYPERLIPIDEMIA, ESSENTIAL (PRIMARY) HYPERTENSION, SECONDARY HYPERPARATHYROIDISM OF RENAL ORIGIN

Other medications

Bumetanide, Sevelamer powder, Ondansetron, Lantus insulin, Rosuvastatin, Pain relieving cream, Lidocaine patch, Tramadol, Famotidine, Rena-Vite, Senexon-S, Diclofenac Gel, Calcium Antacid, Gabapentin, Calcitriol oral solution,

Allergies

NKA