Report #2892387

Received Apr 10, 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: 66 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 14, 2025
Onset: Apr 10, 2026
Days to onset: 178
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052671	IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

MALIGNANT NEOPLASM OF BLADDER, UNSPECIFIED, ACUTE KIDNEY FAILURE, UNSPECUNSPECIFIED DEMENTIA, SEVERE, WITH MOOD DISTURBANCEIFIED, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, ACUTE POSTHEMORRHAGIC ANEMIA

Other medications

Escitalopram, Tamsulosin, Potassium chloride, Famotidine, Quetiapine fumarate, Valproic acid, Fluticasone Propionate nasal spray, Metformin, Polyethylene powder, amlodipine, Alprazolam, Furosemide, Senexon-S , Acetaminophen, Atorvastatin,

Allergies

Codeine, Iodinated Contrast Media, Shell Fish