Report #2878345

Received Dec 17, 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: 15 yrs
State: MA
Recovered: Unknown
Vaccinated: Dec 17, 2025
Onset: Dec 17, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	3053481	IM / LA

Symptoms (1)

Extra dose administered

Symptom narrative

None

Current illness

None

Medical history

Pelviectasis, headache, tremor, history of suicidal ideation, depressed mood, acne vulgaris, scoliosis

Other medications

None

Allergies

None

Lab data

None