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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1398654



Case Details

VAERS ID: 1398654 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-04-08
Onset:2021-06-03
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Surgery
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: had an operation; got the first dose on 08Apr2021 and then got the second dose on 03Jun2021; This spontaneous case was reported by a consumer and describes the occurrence of SURGERY (had an operation) in a 40-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 040A21A and 048B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 03-Jun-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (got the first dose on 08Apr2021 and then got the second dose on 03Jun2021). On an unknown date, the patient experienced SURGERY (had an operation) (seriousness criterion medically significant). At the time of the report, SURGERY (had an operation) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (got the first dose on 08Apr2021 and then got the second dose on 03Jun2021) outcome was unknown. No concomitant medication information provided. Patient got the first dose on 08Apr2021. Patient missed the appointment for second dose due to an operation he had and he got it on 3jun2021. Limited information regarding the events has been provided at this time and is insufficient for causality assessment. Further information has been requested.; Sender''s Comments: Limited information regarding the events has been provided at this time and is insufficient for causality assessment. Further information has been requested.


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