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This is VAERS ID 1371435

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371435
VAERS Form:2
Age:89.0
Sex:Male
Location:Tennessee
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Extra dose administered, No adverse event

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was accidently given a double dose of vaccine. No adverse symptom as of yet.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371435&WAYBACKHISTORY=ON


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