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This is VAERS ID 1454382

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454382
VAERS Form:2
Age:61.0
Sex:Female
Location:Texas
Vaccinated:2021-07-07
Onset:2021-07-07
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 7+ LA / IM

Administered by: Work      Purchased by: ??
Symptoms: No adverse event, Inappropriate schedule of product administration

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: levothyroxone, flonase prn
Current Illness: none
Preexisting Conditions: hypothyrodism
Allergies: NKDA
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient was administered second dose of Moderna on day 23 post the first dose, instead of on day 28. Patient tolerated the vaccine well and stayed the full 15 minutes after administration. No visible adverse event occurred.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454382&WAYBACKHISTORY=ON


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