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This is VAERS ID 1475010

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1475010
VAERS Form:2
Age:22.0
Sex:Male
Location:California
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Incorrect product formulation administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was erroneously administered Pfizer COVID-19 vaccine instead of Moderna COVID-19 vaccine for his 2nd dose. Patient has not had an adverse reaction or symptoms during the observation period.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1475010&WAYBACKHISTORY=ON

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