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Report #2879071

Received Dec 22, 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 13, 2025
Onset
Dec 20, 2025
Days to onset
68
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052671IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE), NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, RHEUMATIC TRICUSPID VALVE DISEASE, UNSPECIFIED, OLD MYOCARDIAL INFARCTION, CARDIOMYOPATHY, UNSPECIFIED,

Other medications

Glargine insulin, Senexon-S, Hydrocodone, Humalog insulin, Sertraline, Morphine, Glutose gel, Potassium chloride, Ipratropium- Albuterol solution, Metolazone, Bumetanide, Levothyroxine, Exelon transdermal patch, Amiodarone, Acetaminophen, M

Allergies

No known allergies