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This is VAERS ID 919637

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 919637
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2020-01-04
Onset:2020-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Inappropriate schedule of product administration

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: No adverse reaction - vaccine was administered to a employee that was 17 years of age


Changed on 5/7/2021

VAERS ID: 919637 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2020-01-04
Onset:2020-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Inappropriate schedule of product administration

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: No adverse reaction - vaccine was administered to a employee that was 17 years of age


Changed on 5/14/2021

VAERS ID: 919637 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2020-01-04
Onset:2020-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Inappropriate schedule of product administration

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: No adverse reaction - vaccine was administered to a employee that was 17 years of age

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=919637&WAYBACKHISTORY=ON

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