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This is VAERS ID 920880

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 920880
VAERS Form:2
Age:15.0
Sex:Female
Location:Washington
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EJ1685 / 1 LA / IM

Administered by: Public      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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient vaccinated outside of age range for vaccine


Changed on 5/7/2021

VAERS ID: 920880 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Washington
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EJ1685 / 1 LA / IM

Administered by: Public      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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient vaccinated outside of age range for vaccine


Changed on 5/14/2021

VAERS ID: 920880 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Washington
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EJ1685 / 1 LA / IM

Administered by: Public      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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient vaccinated outside of age range for vaccine

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=920880&WAYBACKHISTORY=ON


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