Report #2859391

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: Male
Age: 79 yrs
State: AR
Recovered: Unknown
Vaccinated: Jan 10, 2022
Onset: Sep 13, 2025
Days to onset: 1342
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	3	084J21A	IM / LA

Symptoms (1)

COVID-19

Symptom narrative

hospitalized with COVID

Current illness

unknown

Medical history

Coronary Artery Disease, Diabetes, Hyperlipidemia, Hypertension and Other (Afib, Covid x 3)

Other medications

unknown

Allergies

penicillin