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This is VAERS ID 1765452

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1765452
VAERS Form:2
Age:69.0
Sex:Male
Location:Alaska
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 FD0809 / 3 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Extra dose administered, 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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient requested booster dose of Pfizer. Patient did not bring vaccine cards to his booster appointment nor was he in the state vaccine database due to obtaining first vaccines out of State. The medical assistant gave the Pfizer booster based on the patient''s description and verbalized dates. Then the patient brought in his vaccine cards the next day and was found to have had Moderna vaccine for the first 2 doses. Patient had no adverse health events.

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