Adverse Event Reporting

VAERS ID 2520048
Gender Male
Age 83
StateCode PA
Pharmaceutical Company MODERNA
Lot Number 018C22A
Number of vaccinations 5
Vaccinated 2022-11-28
Onset 2022-11-28
  • Incorrect product formulation administered

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations


Laboratory Data


The original monovalent Moderna was sent to the pharmacy labeled Booster Doses Only.
It was not the Bivalent Booster that the pharmacy was expecting.
The monavalent booster was administered before it was discovered that it was not the Bivalent Booster