National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

This is VAERS ID 1365897



Case Details

VAERS ID: 1365897 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient made appointment online for Pfizer first dose shot. Patient came in and verified that this was the patient''s first shot and had already filled out paperwork online. Pharmacist confirmed that this was the first shot for the patient as well before giving the shot. Pharmacist went over the details of the Pfizer 1st dose including the timing of the 2nd shot. Pharmacist informed the patient to stick with Pfizer for the second shot - "no Moderna or JJ" for the 2nd shot. Patient understood and agreed. Pharmacist went on to counsel for side effects and common remedies for symptoms. Patient understood that patient has to wait for 15 minutes post-vaccination before leaving. Pharmacist gave shot and then asked patient to move to waiting area. As patient moved to waiting area, patient asked the pharmacist, "What if he has already gotten the Moderna series though? How would the Pfizer affect him?" Upon hearing this, pharmacist asked the patient to confirm because patient told both pharmacist and technician that this is his first COVID vaccine. He said no, he meant that this was his first Pfizer shot, but he had completed his Moderna series in Feb/March. Pharmacist counseled patient afterwards and advised patient to double check with his physician.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365897


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166