National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1152266

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1152266
VAERS Form:2
Age:16.0
Sex:Female
Location:North Dakota
Vaccinated:2021-03-11
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chills, Cough, Fatigue, Pulmonary congestion, Pyrexia, Product administered to patient of inappropriate age, SARS-CoV-2 test negative

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: Paroxetine and oral birth control (not sure which ones)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient was tested for covid on 3/22/21 and 3/25/21 due to viral illness she thinks she caught while working at daycare center. Her symptoms were chest congestion, cough with lots of phlegm and low grade temp. She was also tested for covid on 3/26/21 at a healthcare facility where she works. All 3 tests were negative.
CDC 'Split Type':

Write-up: 16 year old was vaccinated with Moderna on 3/11/21. Error was found on 3/26/21 by staff reviewing registration list for upcoming covid vaccine clinics. Spoke with patient and her mother on 3/30/21 to report what happened. Patient reported feeling very tired starting on the evening of 3/11/21 and continued until 3/12/21 around bedtime. Also had chills that started on 3/11/21 in the evening and lasted until 5pm on 3/12/21. Denies any other symptoms or problems.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1152266&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166