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This is VAERS ID 1775548

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775548
VAERS Form:2
Age:50.0
Sex:Female
Location:New York
Vaccinated:2021-09-19
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 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: N/A
Current Illness: Patient told us that she didn''t received any COVID shot and we provide 1st dose of Pfizer shot on 09/19/2021. She came for 2nd dose on 10/10/2021. We discovered that she received J&J on 03/24/2021 due to insurance reject.
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Received Pfizer dose on 09/19/21 and she came back for 2nd Pfizer dose on 10/10/21. Due to insurance reject discover that she received J&J on 03/24/21.
CDC 'Split Type':

Write-up: N/A

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