Report #2881463

Received Jan 12, 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: Female
Age: 80 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 29, 2025
Onset: Jan 12, 2026
Days to onset: 75
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052668	IM / RA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, MALIGNANT NEOPLASM OF UNSPECIFIED OVARY , LYMPHEDEMA, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITH UNSPECIFIED ANGINA PECTORIS, PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST,

Other medications

Polyethylene powder, Rosuvastatin, Oyster shell , Melatonin, Donepezil, Lisinopril, Ondansetron, Tolterodine, Mucus relief, Myrbetriq, Metoprolol succinate, Acetaminophen, Loratadine, Omega-3, Clopidogrel

Allergies

Niacin