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This is VAERS ID 1454759

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454759
VAERS Form:2
Age:12.0
Sex:Male
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 047B21A / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Interchange of vaccine products, Product administered to patient of inappropriate age

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: nka
Current Illness: nka
Preexisting Conditions: nka
Allergies: nka
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient was given initial dose on 6/1/2021, dose given at the time was Pfizer. Today, July 7, 2021 patient arrives for 2nd dose, nurse reviewed papers completed by father which states Moderna and the child is given Moderna instead of the Pfizer vaccine. Patient was monitored for the 15 minutes and parent was notified of the error.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454759&WAYBACKHISTORY=ON


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