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This is VAERS ID 1396387

History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1396387
VAERS Form:2
Age:16.0
Sex:Female
Location:Alabama
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 RA / 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? 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: Cetirizine 10mg Fluticasone Hydrocortisone topical cream
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient was given Moderna vaccine #1 that has not yet been approved for patients age 16. No treatment necessary. No adverse effects noted at this time.

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