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This is VAERS ID 1402647

History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1402647
VAERS Form:2
Age:30.0
Sex:Male
Location:Colorado
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Wrong product administered

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: Patient received Pfizer instead of Moderna for 2nd dose. Pt''s 1st dose of Moderna was administered through health department on 4/29/21 and 1st dose did not show in the patient''s chart. The error was discovered right after administration while completing documentation.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1402647&WAYBACKHISTORY=ON

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