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Report #2868234

Received Oct 24, 2025

Hospitalized
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
84 yrs
State
MN
Recovered
Recovered
Vaccinated
Feb 9, 2021
Onset
Oct 2, 2025
Days to onset
1696
Hospital days
4

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA2—UN / UN

Symptoms (2)

COVID-19SARS-CoV-2 test positive

Symptom narrative

Hospitalization related to COVID 19 following completion of primary vaccine series

Current illness

1. Acute foreign body of right cornea (T15.01XA) 2. Bladder cancer (C67.9) 3. Cerumen impaction (H61.20) 4. Nontraumatic compartment syndrome of left lower extremity (M79.A22) 5. Peripheral vascular disease (I73.9) 6. Plantar fasciitis (M72.2) 7. Renal abscess (N15.1) 8. Special screening examination for other infectious diseases (Z11.9)

Medical history

1. Acute foreign body of right cornea (T15.01XA) 2. Bladder cancer (C67.9) 3. Cerumen impaction (H61.20) 4. Nontraumatic compartment syndrome of left lower extremity (M79.A22) 5. Peripheral vascular disease (I73.9) 6. Plantar fasciitis (M72.2) 7. Renal abscess (N15.1) 8. Special screening examination for other infectious diseases (Z11.9)

Other medications

Amoxicillin-Pot Clavulanate 875-125 MG Oral TabletTAKE 1 TABLET EVERY 12 HOURS DAILY.Aspirin 81 MG TABSTAKE 1 TABLET DAILY.Clopidogrel Bisulfate 75 MG Oral TabletTake 1 tablet dailyGabapentin 600 MG Oral TabletEVERY HSlevoFLOXacin 500 MG Or

Allergies

1. No Known Drug Allergies

Lab data

Covid positive test date: 10/2/25, 10/11/25