Report #2858156

Received Sep 11, 2025

Hospitalized

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: 88 yrs
State: MN
Recovered: Recovered
Vaccinated: Mar 16, 2021
Onset: Aug 24, 2025
Days to onset: 1622
Hospital days: 2

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	026A21A	IM / UN

Symptoms (2)

COVID-19SARS-CoV-2 test positive

Symptom narrative

Hospitalization related to COVID 19 following completion of primary vaccine series

Current illness

1. Acid reflux (K21.9)2. Acute bronchitis with bronchospasm (J20.9)3. Callus (L84)4. Cellulitis of great toe of left foot (L03.032)5. Foreign body in left foot, initial encounter (S90.852A)6. Hyperlipidemia (E78.5)7. Hypertension (I10)8. Hypothyroidism (E03.9)9. Lump of skin (R22.9)10. Neuropathic pain (M79.2)11. Onychomycosis of toenail (B35.1)12. Open wound of left middle finger without damage to nail (S61.203A)13. Other hereditary and idiopathic neuropathies (G60.8)14. Tick bite, initial encounter (W57.XXXA)15. Tick bite, sequela (W57.XXXS

Medical history

Other medications

1. Aleve 220 MG Oral Capsule; 1 tabs bid; Therapy: 15Apr2019 to Recorded2. Atorvastatin Calcium 10 MG Oral Tablet; Therapy: (Recorded:01Aug2012) to Recorded3. Carvedilol 6.25 MG Oral Tablet; Therapy: (Recorded:27Apr2015) to Recorded4. Ce

Allergies

1. No Known Allergies

Lab data

Covid positive test date 08/24/2025