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This is VAERS ID 1443424

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1443424
VAERS Form:2
Age:15.0
Sex:Female
Location:California
Vaccinated:2021-06-25
Onset:2021-06-25
Submitted:0000-00-00
Entered:2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Off label use, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received first dose of Moderna at age 15. Per guidance from CDC, patient received 2nd dose off label.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1443424&WAYBACKHISTORY=ON


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