National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 945029

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 945029
VAERS Form:2
Age:16.0
Sex:Male
Location:New Jersey
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / 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? 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: None
Current Illness: None
Preexisting Conditions: Heart Disease
Allergies: None
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: The patient is 16 years old and received the Moderna vaccine. The patient''s mother was contacted immediately after this event was noted approximately 30 minutes after the patient received the vaccination. The mother verbalizes knowing that they were aware of the age requirement but felt due to his physical built of 200lbs and that he should be able to receive the vaccine. The patient not experiencing any adverse reactions as of the last phone call inquiry by this nurse at 4:20 pm. Mother was instructed to seek medical attention for any adverse reactions, she verbalized understanding. Follow up call will be placed to the mother tomorrow,


Changed on 5/7/2021

VAERS ID: 945029 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:New Jersey
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / 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? 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: None
Current Illness: None
Preexisting Conditions: Heart Disease
Allergies: None None
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: The patient is 16 years old and received the Moderna vaccine. The patient''s mother was contacted immediately after this event was noted approximately 30 minutes after the patient received the vaccination. The mother verbalizes knowing that they were aware of the age requirement but felt due to his physical built of 200lbs and that he should be able to receive the vaccine. The patient not experiencing any adverse reactions as of the last phone call inquiry by this nurse at 4:20 pm. Mother was instructed to seek medical attention for any adverse reactions, she verbalized understanding. Follow up call will be placed to the mother tomorrow,


Changed on 5/21/2021

VAERS ID: 945029 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:New Jersey
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / 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? 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: None
Current Illness: None
Preexisting Conditions: Heart Disease
Allergies: None None
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: The patient is 16 years old and received the Moderna vaccine. The patient''s mother was contacted immediately after this event was noted approximately 30 minutes after the patient received the vaccination. The mother verbalizes knowing that they were aware of the age requirement but felt due to his physical built of 200lbs and that he should be able to receive the vaccine. The patient not experiencing any adverse reactions as of the last phone call inquiry by this nurse at 4:20 pm. Mother was instructed to seek medical attention for any adverse reactions, she verbalized understanding. Follow up call will be placed to the mother tomorrow,

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=945029&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166