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This is VAERS ID 1745520

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1745520
VAERS Form:2
Age:16.0
Sex:Female
Location:Georgia
Vaccinated:2021-09-27
Onset:2021-09-29
Submitted:0000-00-00
Entered:2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Interchange of vaccine products

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient''s mother signed her up for Moderna COVID 19 vaccine. I administered Pfizer knowing that patients must be 18 to receive Moderna. In my haste I failed to notify patient''s mother that she was receiving Pfizer instead of Moderna like her consent form requested. I signed COVID card reflecting that patient received Moderna but am certain that the patient received Pfizer. The mother of patient was notified of which vaccine patient actually received and provided with Pfizer Fact Sheet.

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