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This is VAERS ID 1365962

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365962
VAERS Form:2
Age:16.0
Sex:Male
Location:Texas
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy      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? 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: Non
Current Illness: Non
Preexisting Conditions: Non
Allergies: Non
Diagnostic Lab Data: non
CDC 'Split Type':

Write-up: No adverse event. The only issue of concern is that, the patient was less than the 18 years threshold to qualify for the above vaccine.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365962&WAYBACKHISTORY=ON


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