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This is VAERS ID 1330743

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330743
VAERS Form:2
Age:17.0
Sex:Female
Location:Virginia
Vaccinated:2021-04-21
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

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: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Moderna given to client under the age of 18 at time of administration. No adverse events noted.

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