Report #2856507

Received Sep 2, 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: 78 yrs
State: MI
Recovered: Recovered
Vaccinated: Aug 18, 2025
Onset: Aug 18, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
UNK	VACCINE NOT SPECIFIED (OTHER)	UNKNOWN MANUFACTURER	UNK	Y019158	IM
UNK	VACCINE NOT SPECIFIED (OTHER)	UNKNOWN MANUFACTURER	UNK	Y019158	IM

Symptoms (2)

Extra dose administeredNo adverse event

Symptom narrative

Patient was administered the PCV 21 twice on 8/18/2025. No adverse reactions noted.

Medical history

Cerberal infarction, hyperlipidemia, hypertension, open wounds to bilateral lower extremeties, Fracture of T9 and T10, BPH, Venous insufficiency, permanent atrial fibrillation, depression

Allergies

Ambien