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This is VAERS ID 1454430

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454430
VAERS Form:2
Age:74.0
Sex:Male
Location:Ohio
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 036A21A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Extra dose administered, 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: Nursing facility, patient, and patient''s family stated this was patient''s first dose of the Covid vaccine. Vaccine was administered without any issues, however upon entering vaccine into patient''s IMPACTSIIS profile, it was discovered that patient had already received 2 doses of the Pfizer Covid vaccine in March of 2021. Due to the fact that this was not known prior to the patient being administered a Moderna vaccine , patient has now been given 3 total Covid vaccines. Nursing facility was contacted made aware of the situation. Patient will now be monitored by a physician for any adverse effects of the Moderna vaccine and a 2nd Moderna vaccine will not be administered.

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