Report #2891167

Received Mar 30, 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: 78 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 10, 2025
Onset: Mar 29, 2026
Days to onset: 170
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	8146367	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

MULTIPLE SCLEROSIS, UNSPECIFIED, HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITHOUT HEART FAILURE, WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE, THORACIC AORTIC ECTASIA, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, NONRHEUMATIC AORTIC (VALVE) STENOSIS

Other medications

Pregabalin, Tramadol, Senexon-S, Acetaminophen, Polyethylene powder, Carbamazepine, Thera-tabs, Vitamin D3, Bumetanide, Incruse Ellipta inhaler, Duloxetine, Jardiance, Lorazepam, Sodium Chloride flush, Melatonin, Ropinirole, Trospium, Simet

Allergies

Potassium Chloride, Wellbutrin, Statins