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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1440901



Case Details

VAERS ID: 1440901 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO HX
Preexisting Conditions: NO HX
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type: H219

Write-up: PATIENT UNDER AGE FOR APPROVED VACCINE. DENIES ANY SYMPTOMS AT THIS TIME. SPOKE WITH GUARDIAN . SHE WAS INFORMED AND V/U OF WHAT HAPPEN. GUARDIAN HAD NO QUESTIONS AND WAS OK WITH INCIDENT. INCIDENT REPORT FILED WITH .


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