Report #2859373

Received Sep 17, 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: Female
Age: 66 yrs
State: AR
Recovered: Unknown
Vaccinated: Nov 2, 2023
Onset: Sep 5, 2025
Days to onset: 673
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	3031419	IM / LA

Symptoms (1)

COVID-19

Symptom narrative

hospitalized with COVID

Current illness

unknown

Medical history

Coronary Artery Disease, Hyperlipidemia, Hypertension, Reflux and Other (DJD, cardiac stents, chronic back pain, gastritis, renal mass)

Other medications

unknown

Allergies

lisinopril Allergy (Verified 05/03/25 10:49) N&V sulfamethoxazole (From Bactrim) Allergy (Unverified 05/03/25 10:49) Allergic Reactions trimethoprim (From Bactrim) Allergy (Unverified 05/03/25 10:49) Allergic Reactions latex Adverse Reaction (Verified 05/03/25 10:49) HIVES, Blisters Skin