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This is VAERS ID 1470301

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1470301
VAERS Form:2
Age:45.0
Sex:Female
Location:Florida
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 021B21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products, Inappropriate schedule of product administration

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: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient presented to clinic 7/12/2021 at 2:00pm for 2nd COVID vaccine. Patient completed the COVID 19 vaccine screening and consent form and said she was here for her 2nd dose. Nurse, RN asked her if her first dose had been Moderna and the patient said yes. Nurse administered the Moderna vaccine and then the client presented the nurse with her vaccine card which listed Pfizer as the first dose Lot #ER2613 administered by mobile vaccination bus on 5/22/2021 . Nurse informed patient of this. Patient had no adverse reactions and left after 15 min monitoring time.

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