Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|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
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: Paroxetine and oral birth control (not sure which ones)
Current Illness: None
Preexisting Conditions: 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.
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