Report #2874562

Received Nov 24, 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: Age unknown
State: CA
Recovered: Unknown
Vaccinated: Dec 8, 1964
Onset: Dec 8, 1964
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (UNKNOWN))	UNKNOWN MANUFACTURER	UNK	0000000	SYR / UN

Symptoms (1)

Amnesia

Symptom narrative

Systemic: memory loss-Mild, Additional Details: patient was unable to give any details. stated had not reported memory loss . did not know dates wanted call back to leave VM