Report #2863799

Received Oct 7, 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: 60 yrs
State: CA
Recovered: Unknown
Vaccinated: Sep 17, 2025
Onset: Sep 17, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052550	IM / LA

Symptoms (2)

No adverse eventRefusal of vaccination

Symptom narrative

Systemic: no side effect-Mild, Additional Details: pt did not experience any side effects at all, he just did not want to recieve the covid vaccine after he was given it and he did not say anything prior to recieving the vaccine