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This is VAERS ID 925282

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 925282
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: Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: N/A
Preexisting Conditions: Asthma
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reaction noted. Pt was just noted to be < 18 after vaccine administration.


Changed on 5/7/2021

VAERS ID: 925282 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: Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: N/A
Preexisting Conditions: Asthma
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reaction noted. Pt was just noted to be < 18 after vaccine administration.


Changed on 5/21/2021

VAERS ID: 925282 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: Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: N/A
Preexisting Conditions: Asthma
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reaction noted. Pt was just noted to be < 18 after vaccine administration.

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