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This is VAERS ID 1368183

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368183
VAERS Form:2
Age:17.0
Sex:Male
Location:Georgia
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 C54C21A / 1 LA / IM

Administered by: Private      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? 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: None
Current Illness: none
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/1 moderna vaccine- No reactions
CDC 'Split Type':

Write-up: Patient received Moderna vaccination and he is currently 17 years which has not been approved yet for his age. I did call back this morning to follow up with patient but I let a VM to callback for update on how he is feeling.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368183&WAYBACKHISTORY=ON


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