Report #2896133

Received May 11, 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: 68 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 8, 2026
Onset: May 10, 2026
Days to onset: 32
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

VASCULAR DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, ESSENTIAL (PRIMARY) HYPERTENSION

Other medications

Combivent inhaler, Lorazepam, Mirtazapine, Atropine drops, Senexon-S, Citalopram, Risperidone, Polyethylene powder, sodium chloride, melatonin, mineral oil to ears, acetaminophen,

Allergies

Dilantin, Penicillin's