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This is VAERS ID 1750510

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1750510
VAERS Form:2
Age:45.0
Sex:Female
Location:Unknown
Vaccinated:2021-09-30
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Underdose, No adverse event, Syringe issue

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Needle/syringe malfunction upon administering Moderna COVID-19 vaccine to patient on 09/30/2021. Administering provider noted approximately half of the vaccine dose administered, and half wasted. Doctor was consulted via telephone, and recommended 0.25ml to be administered to the patient to complete the full vaccination dose. Patient in agreement. No adverse reactions noted after the post vaccine observation period.

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