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This is VAERS ID 1773532

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First Appeared on 10/15/2021

VAERS ID: 1773532
VAERS Form:2
Age:90.0
Sex:Male
Location:Arkansas
Vaccinated:2021-09-24
Onset:2021-10-01
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Inappropriate schedule of product administration

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: PROTONIX [PANTOPRAZOLE SODIUM SESQUIHYDRATE]; HYDROXYZINE; FLOMAX [TAMSULOSIN HYDROCHLORIDE]; FERROUS SULFATE; TYLENOL; CARAFATE
Current Illness:
Preexisting Conditions: Comments: No medical history information were reported.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose; This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose) in a 90-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039d21a and 039d21a) for COVID-19 vaccination. No medical history information were reported. Concomitant products included PANTOPRAZOLE SODIUM SESQUIHYDRATE (PROTONIX [PANTOPRAZOLE SODIUM SESQUIHYDRATE]), HYDROXYZINE, TAMSULOSIN HYDROCHLORIDE (FLOMAX [TAMSULOSIN HYDROCHLORIDE]), FERROUS SULFATE, PARACETAMOL (TYLENOL) and SUCRALFATE (CARAFATE) for an unknown indication. On 24-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Oct-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose). On 01-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medication use was reported.

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