National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1330784

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330784
VAERS Form:2
Age:17.0
Sex:Female
Location:Michigan
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK RA / IM

Administered by: Private      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: unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: The vaccine is not permitted for patients under the age of 18. Patient was scheduled for a dose and the nurse (myself) overlooked the age of the patient.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330784&WAYBACKHISTORY=ON


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