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This is VAERS ID 948225

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 948225
VAERS Form:2
Age:16.0
Sex:Male
Location:Nebraska
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 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

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: none
Current Illness: none noted
Preexisting Conditions: No
Allergies: no known drug allergies, or food allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine given to 16 year old patient


Changed on 5/7/2021

VAERS ID: 948225 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Nebraska
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 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

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: none
Current Illness: none noted
Preexisting Conditions: No
Allergies: no known drug allergies, or food allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine given to 16 year old patient


Changed on 5/21/2021

VAERS ID: 948225 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Nebraska
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 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

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: none
Current Illness: none noted
Preexisting Conditions: No
Allergies: no known drug allergies, or food allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine given to 16 year old patient

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