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This is VAERS ID 1729489

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1729489
VAERS Form:2
Age:74.0
Sex:Male
Location:California
Vaccinated:2021-09-10
Onset:2021-09-10
Submitted:0000-00-00
Entered:2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: No adverse event, 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: Insulin, Diclofenac Sodium external cream, Escitlopram Oxalate, Finasteride, Gabapentin, Propanolol, Reacrit
Current Illness:
Preexisting Conditions: Aortic Stenosis, Cirrhosis, CKD, Colon Polyps,DM2, Esopahgeal Varices, HTN, Hep C, Liver Neoplasm Malignant Adenocarcenoma, Opiod dependence, Osteorthritis,
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received vaccine 4 days past beyond use date 9/4/21 No adverse outcomes or symptoms reported by patient

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