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This is VAERS ID 921594

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 921594
VAERS Form:2
Age:15.0
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 025-J20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Unevaluable 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: None
Current Illness: Mental Health Issue
Preexisting Conditions:
Allergies: None Known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Covid Vaccination given to person less than 18 years. No complications at this time


Changed on 5/7/2021

VAERS ID: 921594 Before After
VAERS Form:2
Age:15.0
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 025-J20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Unevaluable 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: None
Current Illness: Mental Health Issue
Preexisting Conditions:
Allergies: None Known Known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Covid Vaccination given to person less than 18 years. No complications at this time


Changed on 5/14/2021

VAERS ID: 921594 Before After
VAERS Form:2
Age:15.0
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 025-J20-2A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Unevaluable 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: None
Current Illness: Mental Health Issue
Preexisting Conditions:
Allergies: None Known Known
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Covid Vaccination given to person less than 18 years. No complications at this time

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=921594&WAYBACKHISTORY=ON


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