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This is VAERS ID 1331285

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1331285
VAERS Form:2
Age:17.0
Sex:Male
Location:California
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 034C21A / 2 - / 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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Age 17 years 11 months and 5 days old at time of second dose Moderna vaccine. Patient here with father. Reports no complaints following his first dose of Moderna. Patient here with father. Advised that he was under the required age 18 for vaccine.

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