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This is VAERS ID 1750423

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1750423
VAERS Form:2
Age:73.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-09-27
Onset:2021-09-27
Submitted:0000-00-00
Entered:2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Extra dose administered, No adverse event

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: Not illnesses
Preexisting Conditions: No outstanding health conditions
Allergies: No allergies
Diagnostic Lab Data: N/A - no adverse reactions
CDC 'Split Type':

Write-up: No adverse reaction - third dose (full dose of 0.5ml) was administered without proper implications (only risk factor was age above $g65).

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