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This is VAERS ID 1768280

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1768280
VAERS Form:2
Age:55.0
Sex:Male
Location:Missouri
Vaccinated:2021-10-05
Onset:2021-10-05
Submitted:0000-00-00
Entered:2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: 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: UNKNOWN
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Adhesive Band-Aids Latex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had received the Mederna Vaccine the first 2 doses of COVID 19 vaccine. Patient came in and received the Pfizer vaccine for COVID 19 . as the 3rd dose. Patient did not have any signs or symptoms of adverse reaction to having received the 3rd dose as the Pfizer rather than the Mederna.

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