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This is VAERS ID 1775775

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775775
VAERS Form:2
Age:63.0
Sex:Male
Location:Colorado
Vaccinated:2021-10-10
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 FF2590 / 1 LA / IM

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

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: No hx in system. Unknown
Current Illness: None
Preexisting Conditions: diabetes
Allergies: No allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to pharmacy wanting the booster vaccination. We administered the Pfizer vaccine. When patient came back with his COVID vaccine card to update his initial vaccine series was MODERNA. We failed to verify what his initial vaccine series was before giving the booster,

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