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This is VAERS ID 1347370

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1347370
VAERS Form:2
Age:74.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-05-22
Onset:2021-05-22
Submitted:0000-00-00
Entered:2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Work      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: N/A
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Participant received J&J COVID-19 vaccine on 4/11/21 and should not have received Moderna COVID vaccine. participant answered ''no'' to ever receiving a COVID-19 vaccine in the past on the prescreening questionnaire.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1347370&WAYBACKHISTORY=ON


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