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Report #2901957

Received Jun 30, 2026

Office 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
Female
Age
95 yrs
State
CT
Recovered
Not recovered
Vaccinated
Jun 25, 2026
Onset
Jun 26, 2026
Days to onset
1
Hospital days

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNAUNK3058190IM / LA

Symptoms (6)

AgitationDeliriumFallMental status changesPatient elopementUrine analysis normal

Symptom narrative

Acute change in mental status/delerium from baseline starting day after vaccine administration, 2 falls/found on floor 4 days. New elopement risk/exit seeking. Trazodone PRN agitation/exit seeking

Current illness

None

Medical history

ICD-10 Personal history of urinary (tract) infections Z87.440 04/08/2026 Active ICD-10 Chronic diastolic (congestive) heart failure I50.32 04/08/2026 Active ICD-10 Hypokalemia E87.6 03/10/2026 Active ICD-10 Cough, unspecified R05.9 01/13/2026 Active ICD-10 Dementia in other diseases classified elsewhere, unspecified severity, with agitation F02.811 01/13/2026 Active ICD-10 Repeated falls R29.6 05/21/2025 Active ICD-10 Paroxysmal atrial fibrillation I48.0 05/21/2025 Active ICD-10 Alzheimer's disease, unspecified G30.9 05/21/2025 Active ICD-10 Chronic kidney disease, stage 3b N18.32 05/21/2025 Active ICD-10 Obesity, unspecified E66.9 05/21/2025 Active ICD-10 Hyperlipidemia, unspecified E78.5 05/21/2025 Active ICD-10 Essential (primary) hypertension I10 05/21/2025 Active ICD-10 Hypothyroidism, unspecified E03.9 05/21/2025 Active ICD-10 Muscle weakness (generalized) M62.81 05/21/2025 Active ICD-10 Unsteadiness on feet R26.81 05/21/2025 Active ICD-10 Need for assistance with personal care

Other medications

acetaminophen 325 mg tablet Every 4 Hours - PRN 2 tabs = 650mg, oral, Every 4 Hours - PRN, PRN Temperature >101F 01/13/2026 Active ammonium lactate 12 % cream At Bedtime thin layer, topical, At Bedtime, Apply thin layer to BLE at bedtime

Allergies

No known allergies

Lab data

UA negative