Report #2880447

Received Jan 2, 2026

DiedLife-threateningHospitalizedER / ED visitOffice visitDisabled

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: 89 yrs
State: MO
Recovered: Not recovered
Vaccinated: Jan 25, 2021
Onset: Jul 1, 2021
Days to onset: 157
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	041L20A	SYR / AR
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	011M20R	SYR / UN

Symptoms (2)

DeathMyelodysplastic syndrome

Symptom narrative

Developed Myelodysplastic Syndrome. Death on 3/16/2022

Current illness

Heart issues

Medical history

Heart issues

Other medications

Unknown

Allergies

None

Lab data

Unknown