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This is VAERS ID 1371453

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371453
VAERS Form:2
Age:41.0
Sex:Male
Location:Alaska
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: denies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen at plant for 2nd Covid 19 vaccine with other employees. He had card with Pfzier identified as first Covid vaccine given. He was in line to receive Moderna 2nd vaccine per scheduled vaccines with plant. Advised partifipants they were getting 2nd Moderna and discussed my personal side effects as well as effectiveness of Moderna. After vaccine given one of coworkers noted half of employees, 5 people including patient was there for 2nd Pzier vaccine. Pt was advised of error and discussed potential side effects. He was monitored for 30 minutes with no adverse effects. Hours later contacted employer and pt remained asymtomatic. He is scheduled for recheck exam. Pt did not have an adverse reaction.

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