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This is VAERS ID 1367551

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367551
VAERS Form:2
Age:52.0
Sex:Male
Location:Michigan
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Expired product administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: see below for additional details-Medium, Additional Details: expired vial of Moderna Vaccine was given. Vaccine vial was punctured on May 30, 2021 and was not properly strong-pak''d out of system.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367551&WAYBACKHISTORY=ON


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