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This is VAERS ID 1434089

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1434089
VAERS Form:2
Age:80.0
Sex:Male
Location:Maryland
Vaccinated:2021-06-26
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Inappropriate schedule of product administration

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: The patient was administered his 2nd dose of Modera Covid-19 vaccine 6 days too early. He showed up for his 2nd dose on 06/26/2021 and presented a vaccine record card with a wrong appointment date written on it. The Pharmacist who gave him is 1st dose of Moderana made his appointment for 06/25/21 (21 days). His correct appointment date should have been written as 07/02/2021 (28days). The Pharmacy Manager admitted to making a mistake when she wrote the wrong date on his record card. She said that she later tried calling him to have it corrected but she was unable to reach him at the phone number he gave that Pharmacy.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1434089&WAYBACKHISTORY=ON


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