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This is VAERS ID 1764949

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1764949
VAERS Form:2
Age:67.0
Sex:Female
Location:Missouri
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / 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? 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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given 3rd dose of Covid-19 vaccine, had said she had Pfizer with prior 2 doses. After receiving immunization, RN noted on vaccine card that patient had received Moderna vaccine for first 2 doses. RN called Pfizer to advise, was instructed no further action to be taken. Patient has been notified.

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