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This is VAERS ID 919292

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 919292
VAERS Form:2
Age:17.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: 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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none
CDC 'Split Type': Day2ModernaVaccination

Write-up: I am reporting that the Moderna vaccination was given inadvertently before the minimum age 18 requirement.


Changed on 5/7/2021

VAERS ID: 919292 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: 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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known known
Diagnostic Lab Data: none
CDC 'Split Type': Day2ModernaVaccination

Write-up: I am reporting that the Moderna vaccination was given inadvertently before the minimum age 18 requirement.


Changed on 5/14/2021

VAERS ID: 919292 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-29
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: 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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known known
Diagnostic Lab Data: none
CDC 'Split Type': Day2ModernaVaccination

Write-up: I am reporting that the Moderna vaccination was given inadvertently before the minimum age 18 requirement.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=919292&WAYBACKHISTORY=ON

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