Report #2863070

Received Oct 3, 2025

HospitalizedER / ED 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: 78 yrs
State: IL
Recovered: Unknown
Vaccinated: Oct 1, 2025
Onset: Oct 2, 2025
Days to onset: 1
Hospital days: —

Vaccines (3)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	UNK	3052734	IM
FLU3	INFLUENZA (SEASONAL) (AFLURIA)	SEQIRUS, INC.	UNK	AX4605A	IM / RA
PNC20	PNEUMO (PREVNAR20)	PFIZER\WYETH	UNK	MA2519	IM / LA

Symptoms (6)

AstheniaCulture urine negativeFull blood count normalLoss of personal independence in daily activitiesMetabolic function test normalUrine analysis normal

Symptom narrative

Patient received PCV 20 on 9/24, Afluria on 9/26, and Moderna vaccine on 10/1. Reported weakness and functional decline during therapy and needing more assistance overall. UA/CS and CBC/CMP completed were unremarkable. Resident evaluated by Physiatrist and sent out for evaluation to hospital. Suspicion for either vaccine related illness or neurological illness.

Current illness

WEAKNESS OF THE LOWER EXTREMITIES, LOCALIZED EDEMA, CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE

Medical history

PERIPHERAL VASCULAR DISEASE, Dementia, Atherosclerotic heart disease, TIA, hyperlipidemia, ischemic cardiomyopathy, cerebrovascular disease

Other medications

Probiotic Oral Capsule 250 MG, Aspirin EC Tablet Delayed Release 81 MG, Lisinopril Oral Tablet 5 MG, Multi-Vitamin Oral Tablet, Atorvastatin Calcium Oral Tablet 10 MG, Carvedilol Oral Tablet 3.125 MG, Vitamin D3 Oral Capsule 50 MCG (2000 UT

Allergies

Tylenol

Lab data

Urinalysis 10/3/2025, CBC 10/3/2025, CMP 10/3/2025