| Field | Content |
|---|---|
| VAERS_ID | 1066767 |
| RECVDATE | 2021-03-02 |
| STATE | NV |
| AGE_YRS | 54 |
| CAGE_YR | 54 |
| CAGE_MO | |
| SEX | M |
| RPT_DATE | |
| SYMPTOM_TEXT | Patient presented for 1st dose Moderna, when entering information into EMR an alert came up that the patient had a Pfizer COVID 19 vaccine on 12/15/2020 at another Medical Center. We share an EMR with them. Patient contacted on 3/2/2021. He stated he did not have a vaccine on 12/15/2020 and had never been to another hospital. He was advised to contact other hospitals HIM department. He will continue to receive his second dose at the due time. |
| DIED | |
| DATEDIED | |
| L_THREAT | |
| ER_VISIT | |
| HOSPITAL | |
| HOSPDAYS | |
| X_STAY | |
| DISABLE | |
| RECOVD | |
| VAX_DATE | 2021-02-23 |
| ONSET_DATE | 2021-02-23 |
| NUMDAYS | 0 |
| LAB_DATA | |
| V_ADMINBY | OTH |
| V_FUNDBY | |
| OTHER_MEDS | |
| CUR_ILL | |
| HISTORY | |
| PRIOR_VAX | |
| SPLTTYPE | |
| FORM_VERS | 2 |
| TODAYS_DATE | 2021-03-02 |
| BIRTH_DEFECT | |
| OFC_VISIT | |
| ER_ED_VISIT | |
| ALLERGIES | |
| SYMPTOMS |
|
| Field | Content |
|---|---|
| VAERS_ID | 1066767 |
| VAX_TYPE | COVID19 |
| VAX_MANU | MODERNA |
| VAX_LOT | 001A21A |
| VAX_DOSE_SERIES | 1 |
| VAX_ROUTE | IM |
| VAX_SITE | RA |
| VAX_NAME | COVID19 (COVID19 (MODERNA)) |