Report #2894815

Received Apr 29, 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: 72 yrs
State: IA
Recovered: Unknown
Vaccinated: Nov 21, 2021
Onset: Apr 29, 2026
Days to onset: 1620
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	034F21A	IM / RA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, ABDOMINAL AORTIC ANEURYSM, WITHOUT RUPTURE, UNSPECIFIED, PRESSURE ULCER OF SACRAL REGION, STAGE 4, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, UNSPECIFIED CIRRHOSIS OF LIVER, OTHER OBSTRUCTIVE AND REFLUX UROPATHY

Other medications

Resident admitted on 1/8/2026 these are the medications on that date: Lantus insulin, Fiasp insulin, Atorvastatin, Tramadol, Reguloid, Duloxetine, Diclofenac sodium gel, Polyethylene powder, Bisacodyl suppository, Baclofen, Aspirin, Lidoc

Allergies

No known allergies