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This is VAERS ID 950623

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 950623
VAERS Form:2
Age:17.0
Sex:Female
Location:Washington
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

Administered by: Pharmacy      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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient is 17 years and 10 months and she works at a physical therapy clinic. She answered the screening questions on the website and got the ok to get the vaccine. Vaccine was given to the patient but the EUA for Covid-19 Moderna vaccine is for 18 years and older. The patient did not develop any type of reaction. BUT due to the EUA we had to call the patient after she has already received the vaccine and inform her that we are not able to administer the second dose until further instruction from the AICP.


Changed on 5/7/2021

VAERS ID: 950623 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Washington
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

Administered by: Pharmacy      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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient is 17 years and 10 months and she works at a physical therapy clinic. She answered the screening questions on the website and got the ok to get the vaccine. Vaccine was given to the patient but the EUA for Covid-19 Moderna vaccine is for 18 years and older. The patient did not develop any type of reaction. BUT due to the EUA we had to call the patient after she has already received the vaccine and inform her that we are not able to administer the second dose until further instruction from the AICP.


Changed on 5/21/2021

VAERS ID: 950623 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Washington
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

Administered by: Pharmacy      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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient is 17 years and 10 months and she works at a physical therapy clinic. She answered the screening questions on the website and got the ok to get the vaccine. Vaccine was given to the patient but the EUA for Covid-19 Moderna vaccine is for 18 years and older. The patient did not develop any type of reaction. BUT due to the EUA we had to call the patient after she has already received the vaccine and inform her that we are not able to administer the second dose until further instruction from the AICP.

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