Report #2883738

Received Feb 3, 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: 76 yrs
State: IA
Recovered: Not recovered
Vaccinated: Oct 14, 2025
Onset: Feb 2, 2026
Days to onset: 111
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	—	IM / LA

Symptoms (1)

Death

Symptom narrative

Resident expired

Current illness

Medical history

UNSPECIFIED DEMENTIA,MILD PROTEIN-CALORIE MALNUTRITION ,GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS,VITAMIN D DEFICIENCY,TYPE 2 DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE,HYPOTHYROIDISM,CHRONIC KIDNEY DISEASE, STAGE 3A,ANXIETY DISORDER,DYSPHAGIA, PHARYNGEAL PHASE,RHEUMATIC MITRAL STENOSIS,ESSENTIAL (PRIMARY) HYPERTENSION,ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS,OBSTRUCTIVE SLEEP APNEA,HYPERLIPIDEMIA,BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS, POST-TRAUMATIC STRESS DISORDER, CHRONIC

Other medications

Aspirin, Ammonium Lactate, Doxazosin Mesylate, Escitalopram, Furosemide, Levothyroxine, Buspirone, Divalproex Sodium, Metoprolol Tartrate, Tramadol HCL, Acetaminophen, Hydroxyzine HCL, Quetiapine Fumarate, Lorazepam, Lanus, Humalog

Allergies

Lisinopril, Hydrocortisone