Report #2887755

Received Mar 5, 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: 74 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 15, 2025
Onset: Mar 5, 2026
Days to onset: 141
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052669	IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

SCHIZOAFFECTIVE DISORDER, BIPOLAR TYPE, ESSENTIAL (PRIMARY) HYPERTENSION, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, VITAMIN D DEFICIENCY, UNSPECIFIED,

Other medications

Diclofenac Sodium, triple antibiotic ointment, Hydrocodone- acetaminophen, hydralazine, Lidocaine patch, Lorazepam, Metformin, Glipizide, Atorvastatin, Fluticasone, famotidine, Amlodipine, Polyethylene powder, Clonidine, Aripiprazole, Vitam

Allergies

Clonazepam, Engerix-B