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This is VAERS ID 911988

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 911988
VAERS Form:2
Age:17.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K2019 / 1 AR / 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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna has an EUA from the FDA for patients aged 18 and older. This vaccine was used inappropriately to vaccinate a 17 year old staff member at a clinic hosted by Pharmacy. Patient experienced no adverse effects, but this improper usage of the vaccination requires reporting to VAERS.


Changed on 5/7/2021

VAERS ID: 911988 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K2019 / 1 AR / 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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna has an EUA from the FDA for patients aged 18 and older. This vaccine was used inappropriately to vaccinate a 17 year old staff member at a clinic hosted by Pharmacy. Patient experienced no adverse effects, but this improper usage of the vaccination requires reporting to VAERS.


Changed on 5/14/2021

VAERS ID: 911988 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K2019 / 1 AR / 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? 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Moderna has an EUA from the FDA for patients aged 18 and older. This vaccine was used inappropriately to vaccinate a 17 year old staff member at a clinic hosted by Pharmacy. Patient experienced no adverse effects, but this improper usage of the vaccination requires reporting to VAERS.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=911988&WAYBACKHISTORY=ON


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