Report #2883475

Received Jan 30, 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: 84 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 31, 2025
Onset: Jan 29, 2026
Days to onset: 90
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

MALIGNANT NEOPLASM OF UPPER LOBE, LEFT BRONCHUS OR LUNG, ESSENTIAL (PRIMARY) HYPERTENSION, CHRONIC KIDNEY DISEASE, STAGE 3A, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE , HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITH HEART FAILURE AND STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE, ATHEROSCLEROSIS OF CORONARY ARTERY BYPASS GRAFT(S), UNSPECIFIED, WITH UNSPECIFIED ANGINA PECTORIS,

Other medications

Lidocaine patch, Pantoprazole, Miralax, Ketoconazole cream, Desonide cream, Oxycodone, Metoprolol sulfate,

Allergies

NKA