Report #2892572

Received Apr 13, 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: 91 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 15, 2025
Onset: Apr 12, 2026
Days to onset: 179
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

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED, HYPOTHYROIDISM, UNSPECIFIED, NONRHEUMATIC AORTIC (VALVE) STENOSIS, ANEURYSM OF THE ASCENDING AORTA, WITHOUT RUPTURE, CHRONIC KIDNEY DISEASE, STAGE 3A, ABDOMINAL AORTIC ECTASIA

Other medications

Pantoprazole, Eliquis, Sertraline, PreserVision AREDS, polyethylene powder, Acetaminophen, Cetirizine, Testosterone Cypionate, Docusate Sodium, Ipratropium Bromide nasal solution, Levothyroxine,

Allergies

Doxycycline, Rivastigmine, Cats