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This is VAERS ID 1708829

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1708829
VAERS Form:2
Age:16.0
Sex:Female
Location:California
Vaccinated:2021-08-19
Onset:2021-09-16
Submitted:0000-00-00
Entered:2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Cough, Headache, Pyrexia, Rhinorrhoea, Interchange of vaccine products

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

Write-up: Patient was mistakenly given Moderna Covid Vaccine. It was noticed by staff when patient was called for scheduling of second dose. Mom informed of med error and stated that patient developed the following symptoms after having received the first dose of the vaccine: fever (102 F), chills, headache, cough, runny nose for a couple of days after administration.

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