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This is VAERS ID 925174

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 925174
VAERS Form:2
Age:16.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-01-06
Onset:2021-01-06
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L2A / 1 LA / -

Administered by: Private      Purchased by: ??
Symptoms: No adverse 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: Proair Flovent
Current Illness:
Preexisting Conditions: Asthma
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No reported adverse reaction...Just that patient was given Moderna and is < 18 yrs of age.


Changed on 5/7/2021

VAERS ID: 925174 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-01-06
Onset:2021-01-06
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L2A / 1 LA / -

Administered by: Private      Purchased by: ??
Symptoms: No adverse 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: Proair Flovent
Current Illness:
Preexisting Conditions: Asthma
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No reported adverse reaction...Just that patient was given Moderna and is < 18 yrs of age.


Changed on 5/21/2021

VAERS ID: 925174 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-01-06
Onset:2021-01-06
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L2A / 1 LA / -

Administered by: Private      Purchased by: ??
Symptoms: No adverse 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: Proair Flovent
Current Illness:
Preexisting Conditions: Asthma
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No reported adverse reaction...Just that patient was given Moderna and is < 18 yrs of age.

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