Report #2896149

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: 88 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 28, 2026
Onset: May 10, 2026
Days to onset: 12
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3053485	IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

ESSENTIAL (PRIMARY) HYPERTENSION, UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, CHRONIC KIDNEY DISEASE, UNSPECIFIED, TYPE 2 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATIONS, IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS (CHRONIC), OCCLUSION AND STENOSIS OF UNSPECIFIED CAROTID ARTERY, CARDIAC MURMUR, UNSPECIFIED,

Other medications

Omeprazole, Ferrous sulfate, Trazodone, Lantus, Tresiba, Ketoconazole shampoo, Acetaminophen, Cetirizine, Metformin, Sertraline, Ketotifen fumarate, Fluticasone Propionate, Docusate Sodium,

Allergies

Liraglutide, Lisinopril