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Report #2869918

Received Oct 31, 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
84 yrs
State
OR
Recovered
Unknown
Vaccinated
Oct 31, 2025
Onset
Oct 31, 2025
Days to onset
0
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA7+3052917IM / RA

Symptoms (3)

Breath sounds abnormalDyspnoeaHypoxia

Symptom narrative

COVID-19 vaccine administered by LN at 1253. Resident reported shortness of breath approximately 30-35 minutes after vaccine administration. Resident had hypoxia (SpO2 of 70%) on 6 Liters of oxygen. NP assessed and lung sounds were diminished at the bases posteriorly- she ordered to call 911 for emergency medical services for resident to be sent to ER. EMS left facility with resident at approximately 1351.

Current illness

sepsis, bacteremia

Medical history

CHF, anemia, thrombocytopenia, hypothyroidism, NONRHEUMATIC AORTIC (VALVE) INSUFFICIENCY, HTN, cardiomyopathy, glaucoma, PURE HYPERCHOLESTEROLEMIA, UNSPECIFIED

Other medications

Culturelle Oral Capsule (Lactobacillus Rhamnosus (GG)), Diclofenac Sodium Gel 1 %, GlycoLax Powder (Polyethylene Glycol 3350), Dorzolamide HCl Ophthalmic Solution 2 % (Dorzolamide HCl), Lidocaine External Patch 4 % (Lidocaine), Levothyroxin

Allergies

No Known Allergies