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This is VAERS ID 1697404

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1697404
VAERS Form:2
Age:26.0
Sex:Female
Location:Florida
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 058E21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Interchange of vaccine products, Wrong product 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: unknown
Current Illness: unknown
Preexisting Conditions: no
Allergies: none listed
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient was at the pharmacy to receive a Flucelvax. Patient was given a Moderna in error. Patient received PFIZER on 9/9/2021

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