Adverse Event Reporting

VAERS ID	921917
Gender	Unknown
Age
StateCode	CA
Pharmaceutical Company	MODERNA
Lot Number	025L20L
Number of vaccinations	1
Vaccinated	2020-12-28
Onset	2020-12-28
Condition

Symptoms

• Product storage error

Current Illness

none

Preexisting Conditions

none

Other Medications

none

Previous Vaccinations

Allergies

none

Laboratory Data

temperature logs- monitored and continued to be monitored

Write-up

Edit to Vaccine Excursion Report ID 55197 filled on 12/29/2020 At 845 am on 12/28/ 2020, Moderna, Covid 19 vaccines, arrived at Health Care Center.
Vaccines were placed into Immunization Freezer at temperature range of -5.
6 F at 830 am.
At 845 am freezer temperature noted at 4.
3,12.
0 10.
2 F from 9 am to 930 am.
At 945 am temperature was noted at 3.
9 F.
During the 30-minute temperature rise, vaccine protocol was followed, and a sign was placed on freezer by Lead RN to not use and to not open freezer.
Emergency safety protocol were acted to ensure the viability of all vaccines.
Staff nurse filed a vaccine excursion report on 12/29/2020 with VFC program and incident report.
The case content information, on case number #01832359 per Merck vaccine,? ok to use,? and questioned the nature of the caller?s excursion report.
Moderna vaccine case number MOD20-2372 up to the health officer and provider.
Unknown nature of outcome.
As this has yet to be determined.