Report #2895900

Received May 8, 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: 100 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 23, 2026
Onset: May 8, 2026
Days to onset: 15
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052786	IM / RA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, CHRONIC GOUT, UNSPECIFIED, WITHOUT TOPHUS (TOPHI), CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE), OTHER VENTRICULAR TACHYCARDIA, PRESENCE OF CARDIAC PACEMAKER, SICK SINUS SYNDROME, PAROXYSMAL ATRIAL FIBRILLATION, OTHER NONRHEUMATIC AORTIC VALVE DISORDERS, ESSENTIAL (PRIMARY) HYPERTENSION, NONRHEUMATIC AORTIC (VALVE) STENOSIS,

Other medications

Allopurinol, Gabapentin, Senexon-S, Furosemide, Acetaminophen, Duloxetine, Refresh eye drops, Donepezil, Aspirin, Clopidogrel, Metoprolol, Polyethylene powder,

Allergies

No known allergies