Report #2879077

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: 72 yrs
State: IA
Recovered: Unknown
Vaccinated: May 22, 2024
Onset: Dec 20, 2025
Days to onset: 577
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	207h23-2A	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, TYPE 2 DIABETES MELLITUS WITH DIABETIC POLYNEUROPATHY, UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, CHRONIC VIRAL HEPATITIS C, CARDIOMYOPATHY, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS

Allergies

Sulfa Antibiotics