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Report #2864938

Received Oct 10, 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
11 yrs
State
IN
Recovered
Recovered
Vaccinated
Oct 9, 2025
Onset
Oct 9, 2025
Days to onset
0
Hospital days
—

Vaccines (2)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052579IM / LA
FLU3INFLUENZA (SEASONAL) (FLUCELVAX)SEQIRUS, INC.1407002IM / LA

Symptoms (3)

Injection site painInjection site swellingUrticaria

Symptom narrative

Administered vaccines around 12:30 pm on 10/10/2025, and further concerns for hives around 18:00. Arm had a little bit of swelling around the site of injection and was complaining of pain. Received a dose of diphenhydramine and cortisone cream around 23:30 pm. Hives have resolved as of the morning of 10/11/2025.

Current illness

Being treated for a respiratory infection

Medical history

Interstitial Lung Disease secondary to H1N1/Adenovirus in 2016 which required V/V ECMO and tracheostomy placement with subsequent decannulation in May 2021. In Spring 2023, he developed a tension pneumothorax persistent air leak, leading to chest tube insertion and a CT scan revealing numerous blebs, ground glass opacities, and areas of fibrosis eventually requiring endobronchial valves which have now been removed where he remains on 1 LPM of oxygen via NC. Triston has been evaluated for lung transplan

Other medications

Montelukast, Omeprazole, Budesonide/Formoterol

Allergies

No allergies