Report #2858153

Received Sep 11, 2025

Office visit

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: 67 yrs
State: MN
Recovered: Unknown
Vaccinated: Dec 15, 2023
Onset: Sep 10, 2025
Days to onset: 635
Hospital days: —

Vaccines (5)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	041B21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	025C21A	IM / RA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	3	031H21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	045L21A	IM / RA
COVID19	COVID19 (COVID19 (PFIZER-BIONTECH))	PFIZER\BIONTECH	5	HF9300	IM / LA

Symptoms (3)

CoughOropharyngeal painViral test

Symptom narrative

Cough, sore throat,

Current illness

Unknown

Medical history

DM type 2, asthma, dyslipidemia, hypertension, a fib, PSVT, chronic maxillary sinusitis, hypomagnesemia, hypokalemia, GERD, iron deficiency anemia, spinal stenosis, chronic anticoagulation

Other medications

omeprazole, diazepam, flexeril, tofranil, flonase, amaryl, hydrochlorothiazide, lisinopril, magnesium oxide, metoprolol tartrate, adalat, actoplus met, potassium chloride, viagra, zocor, ferosul, eliquis, albuterol, senokot, mucinex

Allergies

Penicillin, pseudoephedrine, sudafed congestion, cephalexin, environmental allergens, minocycline, pseudoephedrine-apap, sympathomimetics, tetracyclines