Report #2875960

Received Dec 2, 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: 72 yrs
State: WI
Recovered: Unknown
Vaccinated: Dec 2, 2025
Onset: Dec 2, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	7+	3052553	IM / RA
FLU3	INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)	SANOFI PASTEUR	7+	—	IM / LA

Symptoms (1)

Underdose

Symptom narrative

Patient was given a pediatric dosing. Instead of the adult dosing.

Current illness

Medical history

Diabetic

Other medications

atorvastatin (Lipitor) 80 MG tablet, B Complex CAPS, CALCIUM PO, furosemide (Lasix) 20 MG tablet, glipiZIDE CR (Glucotrol XL) 10 MG CR tablet, Glucosamine-Chondroit-Vit C-Mn (GLUCOSAMINE CHONDR 500 COMPLEX) CAPS, metFORMIN ER (Glucophage

Allergies

No allergies