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This is VAERS ID 1328030

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1328030
VAERS Form:2
Age:18.0
Sex:Male
Location:Unknown
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183-H / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Interchange of vaccine products

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received the Pfizer vaccine 28 days following the administration of the Moderna vaccine. The Moderna vaccine was given at a different location than this dose of Pfizer. Patient sat for the recommended 15 minutes for observation. He stated that he felt fine and left for home with his father. Both the patient and his father were told that getting one dose of each is not ideal but that there is no medical concerns associated with this. Told the potential side effects are the same for both vaccines. Told that there is no need for a second Pfizer. Will still be considered fully vaccinated in 2 weeks.

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