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This is VAERS ID 935461

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 935461
VAERS Form:2
Age:15.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

Administered by: Public      Purchased by: ??
Symptoms: Accidental exposure to product

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: No
Current Illness: COVID 12/2020
Preexisting Conditions: NO
Allergies: NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient was given vaccine by mistake.


Changed on 5/7/2021

VAERS ID: 935461 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

Administered by: Public      Purchased by: ??
Symptoms: Accidental exposure to product

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: No
Current Illness: COVID 12/2020
Preexisting Conditions: NO
Allergies: NKDA NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient was given vaccine by mistake.


Changed on 5/21/2021

VAERS ID: 935461 Before After
VAERS Form:2
Age:15.0
Sex:Female
Location:Colorado
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

Administered by: Public      Purchased by: ??
Symptoms: Accidental exposure to product

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: No
Current Illness: COVID 12/2020
Preexisting Conditions: NO
Allergies: NKDA NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient was given vaccine by mistake.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=935461&WAYBACKHISTORY=ON


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