Report #2883740

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 13, 2025
Onset: Feb 3, 2026
Days to onset: 113
Hospital days: —

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Resident expired

Current illness

Medical history

CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE),ANEMIA IN CHRONIC KIDNEY DISEASE,ANXIETY DISORDER, INSOMNIA,OTHER OBSTRUCTIVE AND REFLUX UROPATHY,UNSPECIFIED SYMPTOMS AND SIGNS INVOLVING COGNITIVE FUNCTIONS AND AWARENESS,HYPERPARATHYROIDISM, BENIGN NEOPLASM OF PARATHYROID GLAND,BIPOLAR DISORDER,OBSTRUCTIVE SLEEP APNEA ,BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS,ESSENTIAL (PRIMARY) HYPERTENSION,HYPERLIPIDEMIA,

Other medications

Atorvastatin, Melatonin, Polyethylene Glycol, Quetiapine, Carvedilol, Divalproex SPK, Analgesic Balm, Acetaminophen, Tramadol HCL,

Allergies

NKA