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This is VAERS ID 1440806

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440806
VAERS Form:2
Age:45.0
Sex:Female
Location:Maryland
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 043B21A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: No adverse event, 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: 1) METRONIDAZOLE500MG 1 TAB BY MOUTH TWICE DAILY ; 2) OLANZAPINE [ZYPREXA]2.5 MG TAKE 1 TABLET BY MOUTH EVERY NIGHT AT BEDTIME 3) hydrOXYzine PAM50MG; 1 CAP BY MOUTH TWICE DAILY 4) METFORMIN500MG 1 TAB BY MOUTH TWICE DAILY
Current Illness: None
Preexisting Conditions: Diabetes Mellitus 2; Unspecified psychotic disorder
Allergies: No Kknown Drug allergies
Diagnostic Lab Data: No medical tests. Vitals will be monitored
CDC 'Split Type':

Write-up: She received Pfizer dose on 5/11/2021 lot number EW0171. She received Moderna as a second dose. No adverse reaction noted at the time of the report.

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