Report #2855308

Received Aug 22, 2025

Life-threateningHospitalizedDisabled

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: NY
Recovered: Not recovered
Vaccinated: Sep 12, 2024
Onset: Jan 16, 2025
Days to onset: 126
Hospital days: —

Vaccines (4)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (PFIZER-BIONTECH))	PFIZER\BIONTECH	7+	lm2215	IM / RA
FLU3	INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)	SANOFI PASTEUR	UNK	u8429ba	IM / RA
TDAP	TDAP (BOOSTRIX)	GLAXOSMITHKLINE BIOLOGICALS	UNK	x357e	IM / LA
VARZOS	ZOSTER (SHINGRIX)	GLAXOSMITHKLINE BIOLOGICALS	2	x4535	IM / LA

Symptoms (3)

Anti-neutrophil cytoplasmic antibody positive vasculitisMonoplegiaNeurological symptom

Symptom narrative

ANCA-associated vasculitis, paralyzed left foot, stroke like symptoms (stroke was ruled out), hospitalized for multiple months