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This is VAERS ID 1433268

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1433268
VAERS Form:2
Age:16.0
Sex:Female
Location:Texas
Vaccinated:2021-06-26
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / 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? 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: PATIENT IS 16 YEARS OLD RECEIVING MODERNA WHICH IS ONLY APPROVED FOR 18 YEARS AND UP. AFTER 20 MINUTES OF VACCINATION, PATIENT REPORTED NO SIDE EFFECTS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433268&WAYBACKHISTORY=ON


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