Report #2901799

Received Jun 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: 77 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 14, 2026
Onset: Jun 27, 2026
Days to onset: 74
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

ALZHEIMER'S DISEASE, UNSPECIFIED, DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY , GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, MIXED HYPERLIPIDEMIA, ESSENTIAL (PRIMARY) HYPERTENSION,

Other medications

Acetaminophen, Lorazepam, Tramadol, Trazodone, Mirtazapine, Gabapentin, Miralax Powder, Melatonin, Prazosin, Atorvastatin, Omeprazole, Multivitamin, Docusate sodium, Senna, Citalopram,

Allergies

Bupropion, Buspirone, Meperidine