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This is VAERS ID 933906

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 933906
VAERS Form:2
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK LA / IM

Administered by: Public      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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: VACCINE GIVEN TO PATIENT UNDER THE AGE OF 18.


Changed on 5/7/2021

VAERS ID: 933906 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK LA / IM

Administered by: Public      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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a n/a
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: VACCINE GIVEN TO PATIENT UNDER THE AGE OF 18.


Changed on 5/21/2021

VAERS ID: 933906 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-11
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK LA / IM

Administered by: Public      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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a n/a
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: VACCINE GIVEN TO PATIENT UNDER THE AGE OF 18.

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