Report #2903624

Received Jul 15, 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: 86 yrs
State: IA
Recovered: Unknown
Vaccinated: Oct 25, 2022
Onset: Jul 14, 2026
Days to onset: 1358
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (UNKNOWN))	UNKNOWN MANUFACTURER	UNK	unknown	UN

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

ALZHEIMER'S DISEASE WITH LATE ONSET, DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, SEVERE, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, ANEMIA IN CHRONIC KIDNEY DISEASE, VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL), CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE)

Other medications

Res admitted to our facility on 3/26/2026. These are the following medications resident was on admit date: Simvastatin, Metoprolol, Acetaminophen, therapeutic-M, hydrochlorothiazide, lisinopril, Bisacodyl suppository , milk of magnesia,

Allergies

No known allergies