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This is VAERS ID 1440427

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440427
VAERS Form:2
Age:38.0
Sex:Male
Location:Michigan
Vaccinated:2021-07-01
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Interchange of vaccine products

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

Write-up: AT AN OFF SITE LOCATION HE RECEIVED MODERNA BRAND VACCINE. ON 3/14/2021 HE RECIEVED PFIZER BRAND FROM ANOTHER ORGANIZATION LOT NUMBER WAS EN6202 IN MARCH. HE UNDERSTANDS THE SERIER IS COMPLETE.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440427&WAYBACKHISTORY=ON


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