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This is VAERS ID 919455

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 919455
VAERS Form:2
Age:16.0
Sex:Male
Location:New York
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      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: NA
CDC 'Split Type':

Write-up: Vaccine administered to 16 year old patient in error; FDA authorized emergency use of administered vaccine for patient''s 18 years and older. Patient was monitored for 15 minutes following vaccine administration; no adverse reaction noted.


Changed on 5/7/2021

VAERS ID: 919455 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:New York
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      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: NA
CDC 'Split Type':

Write-up: Vaccine administered to 16 year old patient in error; FDA authorized emergency use of administered vaccine for patient''s 18 years and older. Patient was monitored for 15 minutes following vaccine administration; no adverse reaction noted.


Changed on 5/14/2021

VAERS ID: 919455 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:New York
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      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: NA
CDC 'Split Type':

Write-up: Vaccine administered to 16 year old patient in error; FDA authorized emergency use of administered vaccine for patient''s 18 years and older. Patient was monitored for 15 minutes following vaccine administration; no adverse reaction noted.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=919455&WAYBACKHISTORY=ON

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