Report #2879704

Received Dec 26, 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: Not recovered
Vaccinated: Oct 29, 2025
Onset: Dec 25, 2025
Days to onset: 57
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	UNK	3052668	IM / RA

Symptoms (1)

Death

Symptom narrative

Expired

Current illness

N/A

Medical history

CHRONIC ATRIAL FIBRILLATION, CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE, ESSENTIAL (PRIMARY) HYPERTENSION , HYPERLIPIDEMIA, PRESENCE OF AUTOMATIC (IMPLANTABLE) CARDIAC DEFIBRILLATOR ,CARDIOMYOPATHY, POLYNEUROPATHY,UNSPECIFIED ASTHMA,CHRONIC KIDNEY DISEASE, STAGE 3,GILBERT SYNDROME, IRON DEFICIENCY ANEMIA, OSTEOARTHRITIS,BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS,HYPOTHYROIDISM , VITAMIN D DEFICIENCY, TYPE 2 DIABETES MELLITUS, GENERALIZED ANXIETY

Other medications

ferosul, amiodarone, gabapentin, hydroxyzine, levothyrozine, melatonin, metoprolol, preserVision, torsemide, vitamin B-12, Vitamin D3,advair disku, buspirone, eliquis, entresto, methenamine, potassium chloride, Vitamin C, simethicone, iprat

Allergies

spironolactone, eplerenone, dutasteride, mirtazapine, mold, sawdust, tilactase, amiodarone

Lab data

N/A