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This is VAERS ID 1379024

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1379024
VAERS Form:2
Age:16.0
Sex:Female
Location:Washington
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: 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 was administered 2nd dose on day 16. earliest date should be day 17

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1379024&WAYBACKHISTORY=ON


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