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This is VAERS ID 919834

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 919834
VAERS Form:2
Age:16.0
Sex:Female
Location:New York
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 AR / 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? 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:
Current Illness: None reported. Age 16 at the time of the vaccine. Not identified until after vaccination is complete.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Age at the time of vaccination was 16. Not identified until after the vaccine was administered.


Changed on 5/7/2021

VAERS ID: 919834 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:New York
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 AR / 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? 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:
Current Illness: None reported. Age 16 at the time of the vaccine. Not identified until after vaccination is complete.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Age at the time of vaccination was 16. Not identified until after the vaccine was administered.


Changed on 5/14/2021

VAERS ID: 919834 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:New York
Vaccinated:2020-12-24
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 AR / 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? 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:
Current Illness: None reported. Age 16 at the time of the vaccine. Not identified until after vaccination is complete.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Age at the time of vaccination was 16. Not identified until after the vaccine was administered.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919834&WAYBACKHISTORY=ON


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