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This is VAERS ID 1367990

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367990
VAERS Form:2
Age:16.0
Sex:Female
Location:Illinois
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

Administered by: Senior Living      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: GAVE MODERNA VACCINE TO PATIENT UNDER 18.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367990&WAYBACKHISTORY=ON


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