National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1421495

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1421495
VAERS Form:2
Age:32.0
Sex:Female
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: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: none needed
CDC 'Split Type':

Write-up: Please note: this is not an adverse event rather an administration error The incident occurred in a Sunday afternoon at around 12:45 pm. This patient showed up in the drop-off window asking for getting her second dose of COVID-19 vaccine. The patient came with her husband/boyfriend (relationship unknown) and a translator. The technician asked whether she received her first dose from Moderna. She assured the technician positively and decided to take the shot. After administering the vaccine, I discovered in the vaccine card that the patient received her first dose from Pfizer. While the patient was waiting in the observational area, I called CDC hotline to ensure if she needs further follow-up. An on-call physician assured me that the patient should be fine and should not be re-dosed and also guided me to the CDC recommendation fact sheet. I printed the fact sheet for the patient and assured patient about the CDC recommendation. I observed the patient for 30 minutes and didn''t see any adverse events occurred. Patient left the store without any signs or symptoms of adverse effects.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1421495&WAYBACKHISTORY=ON


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