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This is VAERS ID 1368791

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368791
VAERS Form:2
Age:39.0
Sex:Male
Location:Ohio
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Patient waited 15 min after dose was administered and the patient was fine. Followed up the next day and patient had no side effects.
CDC 'Split Type':

Write-up: Patient received wrong vaccine. Patient received a Moderna vaccine as a first dose but was accidently given Pfizer as a second dose

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368791&WAYBACKHISTORY=ON


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