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This is VAERS ID 1454444

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454444
VAERS Form:2
Age:35.0
Sex:Male
Location:Virginia
Vaccinated:2021-07-06
Onset:2021-07-07
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Extra dose administered

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

Write-up: Patient requested Janssen J&J vaccine. On form, patient denied receiving any previous COVID-19 vaccine of any kind. Shot was administered. When insurance was billed for payment, claim was rejected, stating that one dose of Moderna was given. When given this information, patient denied receiving any Moderna vaccine. Insurance was contacted, and they gave us the date of first shot of Moderna (3/20/21) and the location of the shot. Information was given to patient, patient still denied receiving any Moderna vaccine and said that "he would contact pharmacy to clarify the misbilling and rectify the situation". After trying to contact patient multiple times on both 7/6 and 7/7, we called pharmacy to clarify if vaccine was really given. Pharmacy responded that patient received both doses of Moderna vaccine (first on 3/20/21 and second dose on 4/17/21). Incident report was started after receiving this information. Patient has not return any of our phone calls in reguard to receiving both the full series of Moderna and the Janssen J&J vaccine.

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