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This is VAERS ID 1330654

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330654
VAERS Form:2
Age:70.0
Sex:Male
Location:Michigan
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Underdose, Needle issue

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: As I injected the patient with the dose, the needle was loose on the syringe and the vaccine had leaked out and patient was not given full dose and no was to tell how much actually went in the patients left arm. I was instructed to give a full dose in the patients right arm.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330654&WAYBACKHISTORY=ON


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