Report #2873155

Received Nov 17, 2025

Office 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: 82 yrs
State: NJ
Recovered: Unknown
Vaccinated: Nov 12, 2025
Onset: Nov 12, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	N/A	3052296	IM / LA

Symptoms (2)

PainShoulder injury related to vaccine administration

Symptom narrative

Patient is self reporting potential SIRVA on 11/17/2025. States difficulty lifting arm without pain

Current illness

UNKNOWN

Medical history

UNKNOWN

Other medications

UKNOWN

Allergies

NKA