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This is VAERS ID 935326

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 935326
VAERS Form:2
Age:17.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

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? 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: none
CDC 'Split Type':

Write-up: Moderna is for age 18 and older. Patient is 17 years old.


Changed on 5/7/2021

VAERS ID: 935326 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

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? 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: none
CDC 'Split Type':

Write-up: Moderna is for age 18 and older. Patient is 17 years old.


Changed on 5/21/2021

VAERS ID: 935326 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

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? 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: none
CDC 'Split Type':

Write-up: Moderna is for age 18 and older. Patient is 17 years old.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=935326&WAYBACKHISTORY=ON


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