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This is VAERS ID 1437966

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1437966
VAERS Form:2
Age:24.0
Sex:Male
Location:California
Vaccinated:2021-06-29
Onset:2021-06-29
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Incorrect product formulation administered

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: Nickel, Latex
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient received one dose of Pfizer after receiving one dose of Janssen in March 2021. The patient intentionally misled the pharmacy to receive this vaccine based on a study the patient read in order to boost his immunity,

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1437966&WAYBACKHISTORY=ON


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