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This is VAERS ID 926322

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 926322
VAERS Form:2
Age:17.0
Sex:Female
Location:Minnesota
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Senior Living      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: unkown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: unkown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was 17 years old


Changed on 5/7/2021

VAERS ID: 926322 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Minnesota
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Senior Living      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: unkown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: unkown unkown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was 17 years old


Changed on 5/21/2021

VAERS ID: 926322 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Minnesota
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Senior Living      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: unkown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: unkown unkown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was 17 years old

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=926322&WAYBACKHISTORY=ON


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