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This is VAERS ID 1710052

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1710052
VAERS Form:2
Age:82.0
Sex:Male
Location:Arizona
Vaccinated:2021-08-16
Onset:2021-09-12
Submitted:0000-00-00
Entered:2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 3 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Bell's palsy

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: warfarin metropolol methotraxate folic acid
Current Illness: Rheumatoid Arthritis Atrial Fib
Preexisting Conditions: See Above
Allergies: hexachlorophene
Diagnostic Lab Data: Confirmed by Ophthalmologist
CDC 'Split Type':

Write-up: Bell''s Palsy

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