Report #2904834

Received Jul 27, 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: 79 yrs
State: IA
Recovered: Unknown
Vaccinated: Apr 2, 2026
Onset: Jul 26, 2026
Days to onset: 115
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052786	IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS, GASTROINTESTINAL HEMORRHAGE, UNSPECIFIED, TYPE 2 DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE, CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITH OTHER FORMS OF ANGINA PECTORIS, MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED, SYSTEMIC SCLEROSIS, UNSPECIFIED, OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC)

Other medications

Simethicone, Buprenorphine transdermal patch, Levothyroxine, Morphine, Tramadol, Sennosides-Docusate sodium, Senna, Metformin, Miralax powder, Sertraline, Refresh eye drops, Ipratropium-Albuterol solution, Acetaminophen, Milk of Magnesia, B

Allergies

Gabapentin, Tape