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This is VAERS ID 1744763

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1744763
VAERS Form:2
Age:67.0
Sex:Female
Location:Georgia
Vaccinated:2021-09-29
Onset:2021-09-29
Submitted:0000-00-00
Entered:2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

Administered by: Other      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: Glucos-Chon-MSM-Ca-C-CtCl-SeCu - Tablet Orally. Vitamin B 12 100 MCG Lozenge 1 cap(s) Orally daily. Atorvastatin Calcium 40 mg Tablet 1 tablet Orally Once a day. Losartan Potassium 50 mg Tablet 1 tablet Orally bid. Carve
Current Illness: Hypertension, Hyperlipidemia, Hypothyroidism, GERD
Preexisting Conditions: Same as above
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient had an appointment for their 3rd dose of Pfizer (booster due to age) but was given the Moderna vaccine mistakenly. Patient has not had any problems with the vaccine so far.

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