Report #2901542

Received Jun 26, 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: 85 yrs
State: IA
Recovered: Not recovered
Vaccinated: Oct 9, 2025
Onset: Jun 25, 2026
Days to onset: 259
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	8146367	IM / RA

Symptoms (1)

Death

Symptom narrative

Expired

Current illness

N/A

Medical history

UNSPECIFIED DEMENTIA, NEUROPATHIC BLADDER, HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 5 CHRONIC KIDNEY DISEASE OR END STAGE RENAL DISEASE, CHRONIC KIDNEY DISEASE, STAGE 5, IRON DEFICIENCY ANEMIA, THIAMINE DEFICIENCY, UNILATERAL INGUINAL HERNIA, WITHOUT OBSTRUCTION OR GANGRENE, NOT SPECIFIED AS RECURRENT, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS, PHIMOSIS, BENIGN NEOPLASM OF SPINAL MENINGES, LEGAL BLINDNESS, MODERATE PROTEIN-CALORIE MALNUTRITION, PRESBYOPIA, PRIMARY OPEN-ANGLE GLAUCOMA, BILATERAL, STAGE UNSPECIFIED, UNSPECIFIED HYDRONEPHROSIS, LOW BACK PAIN, THROMBOCYTOPENIA, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, MIXED HYPERLIPIDEMIA, CENTRAL RETINAL VEIN OCCLUSION, RIGHT EYE, WITH MACULAR EDEMA

Other medications

Aspirin, atorvastatin, clopidogrel bisulfate, ketoconazole, latanoprost, omeprazole, polyethylene glycol, refresh celluvisc, dorzolamide hcl, brimonidine tartrate, acetaminophen, mupirocin,

Allergies

chocolate

Lab data

N/A