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This is VAERS ID 946517

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 946517
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Unevaluable event

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: (MODERNA COVID 19 VACCINE EUA) Unknown, tried contacting patient back multiple times but was unsuccessful


Changed on 5/7/2021

VAERS ID: 946517 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Unevaluable event

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: (MODERNA COVID 19 VACCINE EUA) Unknown, tried contacting patient back multiple times but was unsuccessful


Changed on 5/21/2021

VAERS ID: 946517 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Unevaluable event

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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: (MODERNA COVID 19 VACCINE EUA) Unknown, tried contacting patient back multiple times but was unsuccessful

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=946517&WAYBACKHISTORY=ON


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