Report #2882503

Received Jan 20, 2026

DiedER / ED visitOffice visit

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: 79 yrs
State: AZ
Recovered: Not recovered
Vaccinated: Jan 14, 2026
Onset: Jan 16, 2026
Days to onset: 2
Hospital days: —

Vaccines (4)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	UNK	3053115	IM / LA
FLU3	INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)	SANOFI PASTEUR	UNK	ut8829aa	IM / RA
PNC21	PNEUMO (CAPVAXIVE)	MERCK & CO. INC.	1	z013052	IM / RA
RSV	RSV (AREXVY)	GLAXOSMITHKLINE BIOLOGICALS	1	92b39	IM / LA

Symptoms (3)

Cardio-respiratory arrestDeathDyspnoea

Symptom narrative

Patient was transferred to the ER with trouble breathing and ended up going through a full code and passing away

Current illness

Patient was in skilled nursing facility fallowing a hip fracture, she was having trouble breathing and was transferred to the ER and went through full code