National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1745515

Government Disclaimer on use of this data



Case Details

VAERS ID: 1745515 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D12, lisinopril, flipiZIDE ER 2.5mg ER
Current Illness: None known
Preexisting Conditions: Uncontrolled hypertension, non-compliance with medication regimen, Stage 1 Chronic Kidney Disease, hyperparathyriodism, uncontrolled Type 2 Diabetes with hyperglycemia
Allergies: NDKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received Moderna mRNA vaccine on 6/17. She no-showed to her 2nd dose appointment on 7/15. After attempts to administer 2nd vaccine in clinic, plan developed to administer 2nd dose at her home. The writer of this incident requested a dose transfer from another Harbor site but neglected to indicate that the patient needed Moderna. Pfizer dose was dispensed to home care nurse, who gave it to the patient at 11:00am today (9/29). The patient was observed for 20 minutes by the nurse with no adverse symptoms.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1745515


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166