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This is VAERS ID 935671

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 935671
VAERS Form:2
Age:16.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 LA / IM

Administered by: Public      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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine given to a 16 year old. No noted or reported adverse outcome. Vaccine clinic was held at clinic. Clinic was asked if any residents or staff was under 18 and they responded no. Patient turned out to be 16 and a staff worker. Administering RN did not catch the age and when it was entered in to database it flagged.


Changed on 5/7/2021

VAERS ID: 935671 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 LA / IM

Administered by: Public      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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine given to a 16 year old. No noted or reported adverse outcome. Vaccine clinic was held at clinic. Clinic was asked if any residents or staff was under 18 and they responded no. Patient turned out to be 16 and a staff worker. Administering RN did not catch the age and when it was entered in to database it flagged.


Changed on 5/21/2021

VAERS ID: 935671 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Iowa
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 LA / IM

Administered by: Public      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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine given to a 16 year old. No noted or reported adverse outcome. Vaccine clinic was held at clinic. Clinic was asked if any residents or staff was under 18 and they responded no. Patient turned out to be 16 and a staff worker. Administering RN did not catch the age and when it was entered in to database it flagged.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=935671&WAYBACKHISTORY=ON


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