Report #2889258

Received Mar 16, 2026

Life-threateningHospitalizedER / 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: 71 yrs
State: IL
Recovered: Unknown
Vaccinated: Sep 11, 2025
Onset: Sep 14, 2025
Days to onset: 3
Hospital days: 3

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	1	3051995	IM / LA

Symptoms (6)

Anaphylactic reactionHypotensionMast cell activation syndromePulmonary oedemaSyncopeUrticaria

Symptom narrative

Patient experienced uticaria all over body (which patient had previously experienced with covid infection7 months prior) but went to the hospital when he began experiencing anaphylaxis. He was admitted to the hospital and experienced pulmonary edema, hypotension and syncope. After being treated for 3 days he was released and later diagnosed with a mast cell activation syndrome by Clinic.

Current illness

none

Medical history

none

Other medications

Ezetimbe 10mg daily

Allergies

none