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This is VAERS ID 1484632

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1484632
VAERS Form:2
Age:16.0
Sex:Female
Location:Illinois
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 004C21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: 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: Escitalopram
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is 16 years old, does not fall into authorized age group.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484632&WAYBACKHISTORY=ON


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