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This is VAERS ID 935424

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 935424
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
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 037K20A / 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? 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: N/A
Current Illness: UNKOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: GAVE A COVID-19 MODERNA VACCINE TO A 17 YEAR OLD.


Changed on 5/7/2021

VAERS ID: 935424 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
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 037K20A / 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? 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: N/A
Current Illness: UNKOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: GAVE A COVID-19 MODERNA VACCINE TO A 17 YEAR OLD.


Changed on 5/21/2021

VAERS ID: 935424 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
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 037K20A / 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? 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: N/A
Current Illness: UNKOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: GAVE A COVID-19 MODERNA VACCINE TO A 17 YEAR OLD.

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