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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1708620

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Case Details

VAERS ID: 1708620 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: CHRONIC TONSILLITIS
Allergies: PROMETHAZINE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS ONLY 16 AT AGE OF VACCINATION


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1708620


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