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Report #2900105

Received Jun 15, 2026

Died

Reports are unverified and do not show that a vaccine caused an event. Full disclaimer

Overview

Sex
Male
Age
91 yrs
State
IA
Recovered
Unknown
Vaccinated
Apr 8, 2026
Onset
Jun 13, 2026
Days to onset
66
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052786IM / LA

Symptoms (1)

Death

Symptom narrative

resident passed away

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, HEART FAILURE, UNSPECIFIED, ELEVATED PROSTATE SPECIFIC ANTIGEN [PSA], BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS, UNSPECIFIED GLAUCOMA

Other medications

Bacitracin ointment, Acetaminophen, Lisinopril, Hydralazine, Levothyroxine, Jardiance, Ipratropium- Albuterol solution, Advair diskus inhaler, Guaifenesin, Amlodipine, Tamsulosin, Sertraline, Senokot, Loratadine, Furosemide, Aspirin, Polye

Allergies

No known allergies