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This is VAERS ID 1421463

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1421463
VAERS Form:2
Age:31.0
Sex:Male
Location:California
Vaccinated:2021-06-20
Onset:2021-06-20
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: 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: 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.

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