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This is VAERS ID 955508

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 955508
VAERS Form:2
Age:17.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-15
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026020A / 1 OT / IM

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

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:
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC 'Split Type':

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


Changed on 5/7/2021

VAERS ID: 955508 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-15
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026020A / 1 OT / IM

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

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:
Current Illness:
Preexisting Conditions:
Allergies: no known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

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


Changed on 5/21/2021

VAERS ID: 955508 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-15
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026020A / 1 OT / IM

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

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:
Current Illness:
Preexisting Conditions:
Allergies: no known allergies 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=955508&WAYBACKHISTORY=ON


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