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This is VAERS ID 921526

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 921526
VAERS Form:2
Age:13.0
Sex:Female
Location:California
Vaccinated:2021-01-04
Onset:2021-01-04
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

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: 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


Changed on 5/7/2021

VAERS ID: 921526 Before After
VAERS Form:2
Age:13.0
Sex:Female
Location:California
Vaccinated:2021-01-04
Onset:2021-01-04
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

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: 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 Known
Diagnostic Lab Data:
CDC 'Split Type':

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


Changed on 5/14/2021

VAERS ID: 921526 Before After
VAERS Form:2
Age:13.0
Sex:Female
Location:California
Vaccinated:2021-01-04
Onset:2021-01-04
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

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: 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 Known
Diagnostic Lab Data:
CDC 'Split Type':

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

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