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This is VAERS ID 934580

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 934580
VAERS Form:2
Age:16.0
Sex:Female
Location:Oklahoma
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

Administered by: Other      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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient is 16 yo female. She was given Moderna COVID-19 vaccine during an off-site vaccine POD reserved for First Responders and persons aged 65 and older. She should not have been scheduled for this event and nurse administered vaccine without verifying patient''s age. Phone call to patient''s mom, to inform of error. Mother states patient has had no side effects or adverse reactions to Moderna COVID-19 vaccine. Informed that patient will not receive second dose in 4 weeks and also is not eligible to receive Pfizer COVID-19 vaccine due to manufacturer''s recommendation that vaccie is not interchangeable with other COVID-19 products.


Changed on 5/7/2021

VAERS ID: 934580 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Oklahoma
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

Administered by: Other      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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient is 16 yo female. She was given Moderna COVID-19 vaccine during an off-site vaccine POD reserved for First Responders and persons aged 65 and older. She should not have been scheduled for this event and nurse administered vaccine without verifying patient''s age. Phone call to patient''s mom, to inform of error. Mother states patient has had no side effects or adverse reactions to Moderna COVID-19 vaccine. Informed that patient will not receive second dose in 4 weeks and also is not eligible to receive Pfizer COVID-19 vaccine due to manufacturer''s recommendation that vaccie is not interchangeable with other COVID-19 products.


Changed on 5/21/2021

VAERS ID: 934580 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Oklahoma
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

Administered by: Other      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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient is 16 yo female. She was given Moderna COVID-19 vaccine during an off-site vaccine POD reserved for First Responders and persons aged 65 and older. She should not have been scheduled for this event and nurse administered vaccine without verifying patient''s age. Phone call to patient''s mom, to inform of error. Mother states patient has had no side effects or adverse reactions to Moderna COVID-19 vaccine. Informed that patient will not receive second dose in 4 weeks and also is not eligible to receive Pfizer COVID-19 vaccine due to manufacturer''s recommendation that vaccie is not interchangeable with other COVID-19 products.

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