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This is VAERS ID 1467328

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1467328
VAERS Form:2
Age:81.0
Sex:Male
Location:Maine
Vaccinated:2021-07-13
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Extra dose administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT ARRIVED AT STORE 7/13/2021 AND MODERNA VACCINE WAS ADMINISTERED. PT CLAIMED TO HAVE NEVER RECEIVED COVID VACCINE. VACCINE REGISTRY WAS REVIEWED LATER AND FOUND THAT PT HAD RECEIVED: 3/26/2021 - MODERNA (DOSE 1) 4/29/2021 - MODERNA (DOSE 2) 5/28/2021 - JANSSEN (DOSE 1) *7/13/2021 - MODERNA (DOSE 3)*

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