Report #2880465

Received Jan 2, 2026

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: 77 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 14, 2025
Onset: Jan 2, 2026
Days to onset: 80
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052671	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, NEUROCOGNITIVE DISORDER WITH LEWY BODIES, ANXIETY DISORDER, PURE HYPERCHOLESTEROLEMIA, MALIGNANT NEOPLASM OF UNSPECIFIED KIDNEY, PARKINSONISM, UNSPECIFIED ATRIAL FIBRILLATION,

Other medications

Risperidone, Quetiapine, Eliquis, Gabapentin, Metoprolol, Levothyroxine, Furosemide, Simethicone, Buspirone, Acetaminophen, Polyethylene, Atorvastatin, Omeprazole, Sertraline, Fiber-lax, Deep sea nasal spray.

Allergies

Duloxetine, Haloperidol, Nitroglycerin, Sulfamethoxazole, Exelon