National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 921526

Government Disclaimer on use of this data



Case Details

VAERS ID: 921526 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-04
Onset:2021-01-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin 10 mg oral tablet, 10 mg, 1 Tab, ORAL, DAILY, 5 refills Flonase 50mcg/inh nasal spray, 2 Spray, NASAL, As directed fluoride 1 mg oral tablet, chewable, See Instructions, 3 refills
Current Illness: Irregular Menses
Preexisting Conditions: None Known
Allergies: None Known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna Covid Vaccination administered to patient less tan 18 years old


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=921526


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166