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This is VAERS ID 1689784

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1689784
VAERS Form:2
Age:23.0
Sex:Female
Location:New Jersey
Vaccinated:2021-09-10
Onset:2021-09-10
Submitted:0000-00-00
Entered:2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Interchange of vaccine products

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT RECEIVED MODERNA AT OUR FACILITY AS HER FIRST DOSE ON 8/13/21. BUT WHEN PATIENT CAME FOR HER SECOND VACCINE SHE FORGOT TO BRING HER CARD AND HAD A PICTURE ON THE PHONE OF HER VACCINATION CARD. BY MISTAKE THE PERSON WHO RECREATED HER PHYSICAL CARD WROTE PFIZER AS HER FIRST AND SECOND SHOT. THE PATIENT RECIEVED PFIZER AS HER SECOND SHOT AS A RESULT. NO COMPLICATIONS OR SIDE EFFECTS WERE OBSERVED.

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