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This is VAERS ID 1428459

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428459
VAERS Form:2
Age:34.0
Sex:Female
Location:Hawaii
Vaccinated:2021-06-04
Onset:2021-06-04
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: 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:
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&WAYBACKHISTORY=ON


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