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This is VAERS ID 1696564

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696564
VAERS Form:2
Age:46.0
Sex:Male
Location:Unknown
Vaccinated:2021-09-13
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 109B21A / 7+ - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Incorrect dose administered

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

Write-up: The patient was given an injection that was drawn up longer than that is recommended. No reaction seen.

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