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This is VAERS ID 1758650

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1758650
VAERS Form:2
Age:60.0
Sex:Female
Location:Michigan
Vaccinated:2021-10-02
Onset:2021-10-02
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, 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:
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The Patient was given Pfizer Booster after receiving Moderna for the 1st and 2nd doses. The patient has had zero adverse affects.

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