Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||021C21A / 3||LA / IM|
Administered by: Private Purchased by: ??
Symptoms: Extra dose administered, No adverse event, Incorrect product formulation administered
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: No adverse effects noted at time of submission. Patient received complete series of Pfizer vaccine previously, then received Moderna vaccine today (3rd dose of mRNA). Patient did not disclose previous vaccinations, was discovered after the fact. Pfizer dose #1 on 4/30/21, Pfizer dose #2 on 6/24/21, Moderna dose #1 7/15/21.
Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166