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This is VAERS ID 1440685

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440685
VAERS Form:2
Age:60.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-08
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

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

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

Write-up: The patient scheduled himself for his first dose of Moderna. On 03/08/2021 at another vaccine site. Patient did not tell the staff that he had a vaccine. Informed us this was his first vaccine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440685&WAYBACKHISTORY=ON

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