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This is VAERS ID 916466

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 916466
VAERS Form:2
Age:17.0
Sex:Female
Location:Montana
Vaccinated:2020-12-28
Onset:2020-12-31
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Senior Living      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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient is below the minimum recommended age of 18. The patient is 17 years of age. The immunizing pharmacist neglected to catch that the patient was 17 before giving the vaccine. No adverse reactions have been reported - patient has been checked in and is fine with no symptoms or side effects. Simply reporting the dosing of an underage individual.


Changed on 5/7/2021

VAERS ID: 916466 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Montana
Vaccinated:2020-12-28
Onset:2020-12-31
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Senior Living      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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient is below the minimum recommended age of 18. The patient is 17 years of age. The immunizing pharmacist neglected to catch that the patient was 17 before giving the vaccine. No adverse reactions have been reported - patient has been checked in and is fine with no symptoms or side effects. Simply reporting the dosing of an underage individual.


Changed on 5/14/2021

VAERS ID: 916466 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Montana
Vaccinated:2020-12-28
Onset:2020-12-31
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Senior Living      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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient is below the minimum recommended age of 18. The patient is 17 years of age. The immunizing pharmacist neglected to catch that the patient was 17 before giving the vaccine. No adverse reactions have been reported - patient has been checked in and is fine with no symptoms or side effects. Simply reporting the dosing of an underage individual.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=916466&WAYBACKHISTORY=ON

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