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This is VAERS ID 1389572

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1389572
VAERS Form:2
Age:18.0
Sex:Male
Location:California
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy      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)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This is just to report that Nurse gave the patient a Pfizer vaccination instead of his second Moderna. Patient is aware and experienced no side effects

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1389572&WAYBACKHISTORY=ON


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