Report #2857164

Received Sep 7, 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: Female
Age: 69 yrs
State: TX
Recovered: Recovered
Vaccinated: Sep 5, 2025
Onset: Sep 6, 2025
Days to onset: 1
Hospital days: —

Vaccines (3)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	UNK	3051995	IM / LA
UNK	VACCINE NOT SPECIFIED (OTHER)	UNKNOWN MANUFACTURER	UNK	—	IM / RA
UNK	VACCINE NOT SPECIFIED (OTHER)	UNKNOWN MANUFACTURER	UNK	—	IM / RA

Symptoms (1)

Unevaluable event

Symptom narrative

None

Medical history

Primary immunodeficiency

Allergies

Penicillin

Lab data

None