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Report #2876820

Received Dec 9, 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
92 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 31, 2025
Onset
Dec 6, 2025
Days to onset
36
Hospital days
—

Vaccines (2)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052668IM / RA
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052668IM / RA

Symptoms (1)

Death

Symptom narrative

Resident expired

Current illness

On hospice

Medical history

MALIGNANT MELANOMA OF LEFT UPPER LIMB, INCLUDING SHOULDER,CHRONIC PAIN SYNDROME,MODERATE PROTEIN-CALORIE MALNUTRITION, OBSTRUCTIVE SLEEP APNEA (ADULT),ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, CHRONIC KIDNEY DISEASE, STAGE 3A, BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS,TYPE 2 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY,VITAMIN D DEFICIENCY, UNSPECIFIED, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS,IRON DEFICIENCY ANEMIA, DIVERTICULOSIS OF LARGE INTESTINE WITHOUT PERFORATION OR ABSCESS WITHOUT BLEEDING, UNSPECIFIED SYMPTOMS AND SIGNS INVOLVING COGNITIVE FUNCTIONS AND AWARENESS

Other medications

Atorvastatin, Ferrous Sulfate, Finasteride, Lasix, Jardiance, Lidocaine Patch, Lisinopril, Sertraline HCL, Tamsulosin, Ure-Na, B-12, D3, Fiber-Lax, Metoprolol Tartrate, Senna, Metoclopramide HCL, Refresh Tears, Tylenol, Tramadol HCL,

Allergies

KNA