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This is VAERS ID 1759143

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759143
VAERS Form:2
Age:87.0
Sex:Male
Location:North Carolina
Vaccinated:2021-09-30
Onset:2021-09-30
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: Public      Purchased by: ??
Symptoms: Extra dose administered, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Aspirin-Stomachache
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient received Moderna vaccine for primary series (dose 1 & 2), given PFIZER for booster.

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