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This is VAERS ID 1474628

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1474628
VAERS Form:2
Age:43.0
Sex:Male
Location:Oregon
Vaccinated:2021-07-15
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-15
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
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: 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.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1474628&WAYBACKHISTORY=ON

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