Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||477C21A / 2||LA / IM|
Administered by: Private Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: trazodone, atorvastatin, breo ellipta, tizanidine, duloxetine, gabapentin, meloxicam, wellbutrin, furosemide, finasteride, potassium chloride, folic acid, vitamin d2, norco, ca-d3-mag#11-zinc-cupr-man, proventil hfa
Current Illness: none
Preexisting Conditions: hypertension hyperlipidemia RA
Allergies: PCN, lexapro
Diagnostic Lab Data: n/a
CDC 'Split Type':
Write-up: The patient has not experienced an adverse event. This report is being submitted because the patient was given Moderna vaccine for his 2nd dose, but was supposed to receive the Pfizer vaccine.
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