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This is VAERS ID 1484490

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1484490
VAERS Form:2
Age:17.0
Sex:Male
Location:Arkansas
Vaccinated:2021-07-16
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 RA / IM

Administered by: Senior Living      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: N/A
Current Illness: Was covid positive 46 days before vaccine
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Staff member is under the age of 18

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484490&WAYBACKHISTORY=ON


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