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This is VAERS ID 944840

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 944840
VAERS Form:2
Age:17.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-12
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Incorrect product formulation administered

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:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Error: Wrong Vaccine Formulation (ex. different


Changed on 5/7/2021

VAERS ID: 944840 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-12
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Incorrect product formulation administered

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:
Current Illness:
Preexisting Conditions:
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Error: Wrong Vaccine Formulation (ex. different


Changed on 5/21/2021

VAERS ID: 944840 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-12
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Incorrect product formulation administered

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:
Current Illness:
Preexisting Conditions:
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Error: Wrong Vaccine Formulation (ex. different

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=944840&WAYBACKHISTORY=ON


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