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Report #2904093

Received Jul 20, 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
94 yrs
State
IA
Recovered
Unknown
Vaccinated
Apr 14, 2026
Onset
Jul 18, 2026
Days to onset
95
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052786IM / 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, PAROXYSMAL ATRIAL FIBRILLATION, MALIGNANT NEOPLASM OF PROSTATE, SQUAMOUS CELL CARCINOMA OF SKIN, UNSPECIFIED, CARCINOMA IN SITU OF PROSTATE, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, DIVERTICULITIS OF LARGE INTESTINE WITHOUT PERFORATION OR ABSCESS WITHOUT BLEEDING, ATHEROSCLEROSIS OF CORONARY ARTERY BYPASS GRAFT(S) WITHOUT ANGINA PECTORIS,

Other medications

Metoprolol Succinate ER, Senna, Lorazepam, tramadol, Nitroglycerin, Bisacodyl suppository, ferrous sulfate, guaifenesin, Ipratropium-Albuterol solution, Divalproex sodium, Acetaminophen, Mirtazapine, Polyethylene Glycol powder, Docusate sod

Allergies

Donepezil, HYDROcodone, Lisinopril, Sertraline, Venlafaxine, Galantamine