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Report #2887650

Received Mar 4, 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
Nov 5, 2025
Onset
Mar 4, 2026
Days to onset
119
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA18146751IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, PERSONAL HISTORY OF OTHER MALIGNANT NEOPLASM OF LARGE INTESTINE, PAROXYSMAL ATRIAL FIBRILLATION, UNSPECIFIED DIASTOLIC (CONGESTIVE) HEART FAILURE, PRESENCE OF AORTOCORONARY BYPASS GRAFT, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, HYPERLIPIDEMIA,ESSENTIAL (PRIMARY) HYPERTENSION, BIPOLAR DISORDER,

Other medications

Tums, Trazodone, Symbicort inhaler, Rosuvastatin, Polyethylene Glycol powder, Metformin, Duloxetine, Pantoprazole, Senexon-S, Ferrous sulfate, Tramadol, Xarelto, Isosorbide, Sodium chloride irrigation, Lidocaine patch, Melatonin, Bisacodyl

Allergies

Bupropion, Chlordiazepoxide, Morphine, Ranitidine, Simvastatin, Varenicline, Zyban