Report #2879190

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: 92 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 10, 2025
Onset: Dec 21, 2025
Days to onset: 72
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	8146367	IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

SECONDARY MALIGNANT NEOPLASM OF LEFT LUNG, MALIGNANT NEOPLASM OF UNSPECIFIED KIDNEY, EXCEPT RENAL PELVIS, HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE, TYPE 2 DIABETES MELLITUS WITH DIABETIC POLYNEUROPATHY, HYPOTHYROIDISM, PURE HYPERCHOLESTEROLEMIA

Other medications

omeprazole, Urinary pain relief, Fiasp insulin, Lactobacillus, Acetaminophen , Tramadol, Atenolol, Levothyroxine, PerserVision AREDS, Docusate sodium, Pain relieving cream, Tresiba insulin, Senexon - S, Tamsulosin, Finasteride, Polyethylene

Allergies

Voltaren, Penicillin's, Sulfa Antibiotics