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This is VAERS ID 1434504

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1434504
VAERS Form:2
Age:58.0
Sex:Male
Location:Hawaii
Vaccinated:2021-06-21
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Malaise, Extra dose administered

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Had completed two doses of Pfizer vaccine but did not disclose to vaccination staff therefore was given a dose of Moderna vaccine. Reported that he did not feel well the next day after receiving the Moderna dose, was in bed for the entire day, which resolved the next day.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1434504&WAYBACKHISTORY=ON


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