Report #2861370

Received Sep 25, 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: Male
Age: 42 yrs
State: CO
Recovered: Recovered
Vaccinated: Sep 24, 2025
Onset: Sep 24, 2025
Days to onset: 0
Hospital days: —

Vaccines (4)

Type	Name	Manufacturer	Dose	Lot	Route / Site
FLU3	INFLUENZA (SEASONAL) (FLULAVAL)	GLAXOSMITHKLINE BIOLOGICALS	UNK	F4A7R	IM / LA
HEP	HEP B (ENGERIX-B)	GLAXOSMITHKLINE BIOLOGICALS	1	9K34M	IM / RA
IPV	POLIO VIRUS, INACT. (IPOL)	SANOFI PASTEUR	1	Y1D03P1	IM / RA
UNK	VACCINE NOT SPECIFIED (OTHER)	UNKNOWN MANUFACTURER	UNK	Y013583	SC / RA

Symptoms (1)

Inappropriate schedule of product administration

Symptom narrative

No abnormal signs and symptoms noted. Invalid dose and will readminister MMR alone in 4 weeks.

Current illness

HLD

Medical history

HLD

Other medications

Rosuvastatin

Allergies

NKDA

Lab data

N/A

Prior vaccinations

Record reveals 7/30/2020 severe pain related to Tdap that was received in the ER. Unk brand name.