Report #2851934

Received Jul 31, 2025

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: 84 yrs
State: WI
Recovered: Unknown
Vaccinated: Nov 21, 2023
Onset: Nov 21, 2023
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	—	IM / LA
FLU4	INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT)	SANOFI PASTEUR	UNK	U8156AA	IM / RA

Symptoms (2)

RashVomiting

Symptom narrative

Reported Symptoms: 10037844:RASH; 10047700: VOMITING; Narrative: Other Relevant HX: Other: