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This is VAERS ID 1367839

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367839
VAERS Form:2
Age:21.0
Sex:Female
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 / 2 RA / 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 additional comments-Medium, Additional Details: pt was given expired vial of moderna; it was punctured on may 30 2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367839&WAYBACKHISTORY=ON


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