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This is VAERS ID 955506

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 955506
VAERS Form:2
Age:15.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-28
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3248 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Wrong patient received product

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:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Error: Wrong Patient (documentation in EMR)


Changed on 5/7/2021

VAERS ID: 955506 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-28
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3248 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Wrong patient received product

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:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Error: Wrong Patient (documentation in EMR)


Changed on 5/21/2021

VAERS ID: 955506 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-28
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3248 / 1 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Wrong patient received product

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:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Error: Wrong Patient (documentation in EMR)

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=955506&WAYBACKHISTORY=ON


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