Report #2845361

Received Jun 17, 2025

Life-threateningHospitalizedER / ED visitOffice visitDisabled

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: Female
Age: 36 yrs
State: FL
Recovered: Unknown
Vaccinated: Sep 20, 2021
Onset: Jan 7, 2022
Days to onset: 109
Hospital days: 3

Vaccines (3)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	—	SYR / AR
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	—	SYR / AR
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	3	—	SYR / AR

Symptoms (1)

Unevaluable event

Symptom narrative

None stated.

Current illness

Asthma

Medical history

Psoriatic Arthritis, ANA Positive, Full Hysterectomy, tricuspid valve dysfunction, Atrial Fibrillation with RVR

Other medications

Vitamin C, Vitamin D, Zinc, Gabapentin, Wellbutrin, Xarelto

Allergies

Corn