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VAERS ID: 1862168

AGE: 8| SEX: F|State: MI

Description

Nothing at the moment (5 hours have passed). Patient came in for the Pfizer kids shot but received a dose of a booster shot of Moderna.

Symptoms

Interchange of vaccine products

Vaccines

VAX DATE: 10 November 2021 | ONSET DATE: 10 November 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))
  • 1
  • IM
  • LA
  • 066F21A

RECVDATE:
10 November 2021
CAGE_YR:
8
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
U
LAB_DATA:
V_ADMINBY:
PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
10 November 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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