Report #2874633

Received Nov 24, 2025

ER / ED visitOffice 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: 78 yrs
State: MI
Recovered: Not recovered
Vaccinated: Oct 24, 2025
Onset: Oct 29, 2025
Days to onset: 5
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	N/A	3053483	IM / LA
FLU3	INFLUENZA (SEASONAL) (FLUAD)	SEQIRUS, INC.	N/A	3053483	IM / RA

Symptoms (1)

Shoulder injury related to vaccine administration

Symptom narrative

Patient stated that they were diagnosed with SIRVA shoulder within days of the vaccine

Other medications

metoprolol, amlodipine, trelegy, rosuvastati

Allergies

none

Lab data

unknown by me