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This is VAERS ID 1696887

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696887
VAERS Form:2
Age:18.0
Sex:Female
Location:North Dakota
Vaccinated:2021-09-14
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products

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: Patient presents for her second COVID-19 vaccination, she did not have her vaccine card with her at the time of her second dose and she did not remember what vaccine she received for her first dose. It was written on a sticky note that she was due for Pfizer dose today 09-14-2021. Medication removed from fridge, mixed per directions, and administered per standing orders. Writer did not check system prior to administration of vaccine. Patient monitored for 15 minutes after administration with no adverse reaction and was released back to work. After patient was released, I went to put vaccine in system it was figured out that she was administered Moderna on 08-17-2021 and Pfizer was administered today 09-14-2021. Pt notified at this time.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1696887&WAYBACKHISTORY=ON

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