Report #2863739

Received Oct 7, 2025

ER / 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: 69 yrs
State: CA
Recovered: Recovered
Vaccinated: Sep 20, 2025
Onset: Sep 20, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19-2	COVID19 (COVID19 (MODERNA BIVALENT))	MODERNA	1	3052087	IM / LA

Symptoms (11)

Anaphylactic reactionAstheniaDizzinessDysphagiaHeadacheInjection site painNauseaPyrexiaThroat tightnessTremorVomiting

Symptom narrative

Site: Pain at Injection Site-Mild, Systemic: Allergic: Anaphylaxis-Mild, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fever-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild, Systemic: Shakiness-Mild, Systemic: Vomiting-Mild, Systemic: Weakness-Mild, Other Vaccines: VaccineTypeBrand: mnexspike 2025-26; Manufacturer: moderna; LotNumber: 3052087; Route: im; BodySite: left arm; Dose: ; VaxDate: UNKNOWN