Report #2867608

Received Oct 22, 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: Recovered
Vaccinated: Oct 21, 2025
Onset: Oct 21, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	1	3053732	IM / LA
FLU3	INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)	SANOFI PASTEUR	1	UT8794CA	IM / LA

Symptoms (1)

Product administered to patient of inappropriate age

Symptom narrative

Patient at an off-site clinic received a high dose flu shot because he filled out a consent form notating that he was 65 years old. Patient confirmed with intake technician and company assistant that he was 65 years old. After processing claim, it was discovered that patient was 60 years old. Patient was called a day later and told about the vaccine being the incorrect one administered and he said he was ok and that he made the mistake of putting his birth year as his age.

Current illness

unknown

Medical history

unknown

Other medications

unknown

Allergies

n/a

Lab data

n/a