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This is VAERS ID 1775320

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775320
VAERS Form:2
Age:16.0
Sex:Female
Location:Oregon
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-09
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
Died? No
Permanent Disability? No
Recovered? No
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: 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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