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This is VAERS ID 1440901

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1440901
VAERS Form:2
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2021-07-01
Onset:2021-07-01
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

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: 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440901&WAYBACKHISTORY=ON

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