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This is VAERS ID 1454807

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454807
VAERS Form:2
Age:17.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-07-07
Onset:2021-07-07
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna Covid-19 vaccine administered to a 17 year old. no resulting reactions or problems noted. reported to parent and consulted CDC protocol

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454807&WAYBACKHISTORY=ON


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