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This is VAERS ID 1232052

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1232052
VAERS Form:2
Age:16.0
Sex:Male
Location:Alaska
Vaccinated:2021-03-14
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: MODERN 0.5 ML FOR IM LOT 015M201A EPX:07/31/2021 No known adverse events.


Changed on 5/7/2021

VAERS ID: 1232052 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Alaska
Vaccinated:2021-03-14
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: MODERN 0.5 ML FOR IM LOT 015M201A EPX:07/31/2021 No known adverse events.


Changed on 5/14/2021

VAERS ID: 1232052 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Alaska
Vaccinated:2021-03-14
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: MODERN 0.5 ML FOR IM LOT 015M201A EPX:07/31/2021 No known adverse events.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1232052&WAYBACKHISTORY=ON


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