Report #2890633

Received Mar 24, 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 28, 2025
Onset: Mar 23, 2026
Days to onset: 146
Hospital days: —

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

IDIOPATHIC PULMONARY FIBROSIS, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED, HEART FAILURE, UNSPECIFIED, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, HYPERLIPIDEMIA, UNSPECIFIED, VENTRICULAR PREMATURE DEPOLARIZATION, CHRONIC PAIN SYNDROME, GOUT, UNSPECIFIED

Other medications

Clopidogrel Bisulfate, Duloxetine, Isosorbide Mononitrate, Pantoprazole, Furosemide, Senexon-S, Lisinopril, Metoprolol Succinate ER, PreserVision AREDS, Jardiance, Ferrous Sulfate, Aspirin, Oxycodone, Spironolactone, Biofreeze, Refresh eye

Allergies

Sulfamethoxazole