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Report #2877041

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
76 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 31, 2025
Onset
Dec 8, 2025
Days to onset
38
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA18146751IM / RA

Symptoms (1)

Death

Symptom narrative

Expired

Medical history

HEMIPLEGIA AND HEMIPARESIS FOLLOWING UNSPECIFIED CEREBROVASCULAR DISEASE AFFECTING RIGHT DOMINANT SIDE,UNSPECIFIED ATRIAL FIBRILLATION,APHASIA FOLLOWING CEREBRAL INFARCTION, ESSENTIAL (PRIMARY) HYPERTENSION,ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, TYPE 2 DIABETES MELLITUS WITH DIABETIC AUTONOMIC (POLY)NEUROPATHY,OTHER EPILEPSY, MODERATE PROTEIN-CALORIE MALNUTRITION,DEPRESSION, POST-TRAUMATIC STRESS DISORDER, UNSPECIFIED,HYPERLIPIDEMIA,UNSPECIFIED ASTHMA, NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY, OTHER INTERVERTEBRAL DISC DISPLACEMENT, LUMBAR REGION, GASTROPARESIS ,,POLYNEUROPATHY, HEART FAILURE, FIBROMYALGIA, DYSPHAGIA, PERSONAL HISTORY OF PULMONARY EMBOLISM

Other medications

Tylenol, atorvastatin, Digoxin, Fluticasone Proplonate, Jardiance, Lidocaine Patch, Metoprolol Succinate ER, Omeprazole, Sertraline HCL, Tamsulosin HCL, Tramadol, D3, Azelastine HCL, Senexon-S, Analgesic Balm,

Allergies

Novacaine, Procaine, Oxybutynin Chloride/Polysorbate, Tolterodine