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This is VAERS ID 1376039

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376039
VAERS Form:2
Age:70.0
Sex:Female
Location:Oregon
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Wrong product administered

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: Pt was given Pfizer today and given Moderna on 5/7/21
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given Pfizer vaccine as the second vaccine in the series when pt had Moderna as 1st vaccine in the series. Pt had no adverse reaction to the vaccine today.

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