National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

This is VAERS ID 1421463



Case Details

VAERS ID: 1421463 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Please Note: this is not an adverse effect reporting rather an administration error The incident happened on Sunday afternoon while I was working at a retail pharmacy. This patient came to our drop-off window at around 12:40 PM to get his 2nd dose of COVID-19 vaccine without any prior appointment. They couldn''t speak language well and had an interpreter to translate. They were asked by my technician whether they received their first dose of COVID-19 vaccine from Moderna since we only offer Moderna in our store. They assured her and wanted to proceed with the second dose. After administering the dose, I discovered that he received his first dose from Pfizer from another location. I called CDC right away asking for advise while the patient was waiting in the observation area. The on-call physician told me that it is not an issue since CDC has a fact sheet regarding this and he guided me where to find the information. I printed the fact sheet and assured patient that he is not required to take any further dose as recommended by CDC guidelines. I observed the patient for 30 minutes for any signs or symptoms of adverse events. Except for patient being scared, nothing was observed. Patient went home without any issues.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1421463


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166