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This is VAERS ID 1741884

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1741884
VAERS Form:2
Age:75.0
Sex:Male
Location:California
Vaccinated:2021-09-27
Onset:2021-09-27
Submitted:0000-00-00
Entered:2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: 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: simvastatin, vitamin c, multivitamins, magnesium sulfate, latanoprost, lisinopril-hctz, glucosamine-chondroitin, systane balance
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia, renal stones, impaired fasting glucose, glaucoma, osteoarthritis
Allergies: combigan
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient was accidentally given a Pfizer COVID booster after initial Moderna COVID vaccinations

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