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This is VAERS ID 1431518

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1431518
VAERS Form:2
Age:61.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-06-26
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Device connection issue, Syringe issue

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Syringe had a crack in it where it connected to the needle and the vaccine leaked out onto patient''s arm instead of being administer. Patient was then given another dose because the patient received very little if anything at all of the initial dose

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1431518&WAYBACKHISTORY=ON


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