Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|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
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
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
Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166