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This is VAERS ID 1391647

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1391647
VAERS Form:2
Age:56.0
Sex:Male
Location:Florida
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / UNK LA / IM

Administered by: Public      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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine administered after 30 days of refrigeration

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1391647&WAYBACKHISTORY=ON


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