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This is VAERS ID 1376431

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376431
VAERS Form:2
Age:20.0
Sex:Male
Location:California
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Inappropriate schedule of product administration

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient received 2nd dose of Pfizer COVID vaccine early. Patient received 1st dose on 5/21/21 and then received 2nd dose on 6/4/21. He received the 2nd dose 2 weeks after 1st dose. We tried to contact patient but unable to reach him.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376431&WAYBACKHISTORY=ON


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