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This is VAERS ID 907882

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907882
VAERS Form:2
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 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: Sertraline, Metformin ER, Tri-Linyah
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: THERE WAS NO ADVERSE EVENT. We realized after administration that we had inadvertently given the vaccine to a 15 year old girl. She is not having any symptoms or problems. We have been monitoring her and encouraged her to speak with us if she has any issues at all.


Changed on 5/7/2021

VAERS ID: 907882 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 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: Sertraline, Metformin ER, Tri-Linyah
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: THERE WAS NO ADVERSE EVENT. We realized after administration that we had inadvertently given the vaccine to a 15 year old girl. She is not having any symptoms or problems. We have been monitoring her and encouraged her to speak with us if she has any issues at all.


Changed on 5/14/2021

VAERS ID: 907882 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-21
Onset:2020-12-21
Submitted:0000-00-00
Entered:2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 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: Sertraline, Metformin ER, Tri-Linyah
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: THERE WAS NO ADVERSE EVENT. We realized after administration that we had inadvertently given the vaccine to a 15 year old girl. She is not having any symptoms or problems. We have been monitoring her and encouraged her to speak with us if she has any issues at all.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907882&WAYBACKHISTORY=ON


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