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This is VAERS ID 1775445

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775445
VAERS Form:2
Age:60.0
Sex:Male
Location:North Carolina
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 2 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Interchange of vaccine products

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: PATIENT CAME IN FOR HIS SECOND DOSE OF MODERNA AND TECHNICIAN GAVE PATIENT PFIZER -BioNTech INSTEAD

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