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This is VAERS ID 1469934

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1469934
VAERS Form:2
Age:19.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-07-13
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Incorrect product formulation administered

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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1469934&WAYBACKHISTORY=ON


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