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

This is VAERS ID 1428459



Case Details

VAERS ID: 1428459 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

Administered by: Public       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received one dose of Moderna and one dose of Johnson and Johnson''s Janssen vaccine. Patient did not report any adverse reactions/side effects.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1428459


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