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This is VAERS ID 946607

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 946607
VAERS Form:2
Age:17.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / 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? 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: None
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Moderna vaccine administered off label to 17 year old.


Changed on 5/7/2021

VAERS ID: 946607 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / 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? 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: None None
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Moderna vaccine administered off label to 17 year old.


Changed on 5/21/2021

VAERS ID: 946607 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / 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? 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: None None
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Moderna vaccine administered off label to 17 year old.

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