Report #2884810

Received Mar 30, 2026

Disabled

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: 87 yrs
State: CA
Recovered: Not recovered
Vaccinated: Oct 17, 2025
Onset: Oct 17, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19-2	COVID19 (COVID19 (MODERNA BIVALENT))	MODERNA	1	3052087	IM / LA
COVID19	COVID19 (COVID19 (UNKNOWN))	UNKNOWN MANUFACTURER	1	3052087	IM / LA

Symptoms (4)

Injection site painPainPain in extremityInjection site swelling

Symptom narrative

Site: Pain at Injection Site-Medium, Site: Swelling at Injection Site-Mild, Other Vaccines: VaccineTypeBrand: Fluzone High Dose; Manufacturer: ; LotNumber: ut8794da; Route: IM; BodySite: left arm; Dose: ; VaxDate: UNKNOWN

Allergies

N/A