VAERS ID: 2275468

AGE: 84| SEX: F|STATE: VA

Description

Error: Improper Storage (ex. temp./location)-

Symptoms

Product storage error

Vaccines

VAX DATE: 04-06-2022| ONSET DATE: 04-06-2022| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 3 COVID19 MODERNA 027L21A IM LA

RECVDATE:05-13-2022
RPT_DATE:
CAGE_YR:84
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:05-13-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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