Report #2878265

Received Dec 17, 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: 78 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 31, 2025
Onset: Dec 17, 2025
Days to onset: 47
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

PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS, ATHEROSCLEROSIS OF NATIVE ARTERIES OF EXTREMITIES WITH INTERMITTENT CLAUDICATION, UNSPECIFIED EXTREMITY, ESSENTIAL (PRIMARY) HYPERTENSION, SEBORRHEIC DERMATITIS, PERIPHERAL VASCULAR DISEASE, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED, PSYCHOTIC DISORDER WITH DELUSIONS DUE TO KNOWN PHYSIOLOGICAL CONDITION

Other medications

Senna, Sodium Fluoride dental cream, Clobetasol Cream, Simethicone, Loratadine, Carbidopa- Levodopa, Dicyclomine, Miconazole cream, Aspirin, Amlodipine, Albuterol Sulfate, Polyethylene powder, Ketoconazole cream, Mirtazapine, Propranolol, H

Allergies

Amoxicillin, Atorvastatin, Haloperidol, Metformin, Simvastatin, Sitagliptin, Tetanus Toxoids