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This is VAERS ID 1368747

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368747
VAERS Form:2
Age:71.0
Sex:Female
Location:Texas
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 021C21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Extra dose administered

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: Moderna COVID-19 Vaccine EUA: Higher-than-authorized dose volume administered Patient received 0.5 ml dose of Moderna Covid Vaccine on 1/11/21 and a 1 ml dose of Moderna Covid vaccine on 6/1/21.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368747&WAYBACKHISTORY=ON


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