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This is VAERS ID 1368135

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368135
VAERS Form:2
Age:18.0
Sex:Male
Location:New York
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 RA / IM

Administered by: Private      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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Pt received Moderna vaccine on 5/4/21. Then again on 6/1/21. Was inadvertently also vaccinated with Pfizer vaccine on 6/1/21 so had both Moderna and Pfizer vaccines on the same day in different arms

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368135&WAYBACKHISTORY=ON


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