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This is VAERS ID 1690131

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1690131
VAERS Form:2
Age:25.0
Sex:Female
Location:Illinois
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 FC3184 / 2 LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Exposure during pregnancy, 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: The event actually occurred at the mixing of the vaccine Pfizer vaccine was diluted with 1.8ml of Moderna vaccine instead of sodium chloride vaccine patient due in November

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