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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||011F21A / 1||LA / IM|
Administered by: Pharmacy Purchased by: ??
Symptoms: Product administered to patient of inappropriate age, Wrong product administered
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: The patient, who is 16 years of age, was given Moderna vaccine in error. She should have received the Pfizer vaccine.
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