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This is VAERS ID 1388374

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1388374
VAERS Form:2
Age:21.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? Yes
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: Pineapple
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Patient was given second dose of Moderna vaccine at a 21 day interval not 28

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1388374&WAYBACKHISTORY=ON


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