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This is VAERS ID 951410

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951410
VAERS Form:2
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2021-01-17
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / SYR

Administered by: Senior Living      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? 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: Patient denies prescriptions, OTC, herbal or dietary supplements.
Current Illness: Patient denies any illnesses one month prior to vaccination date.
Preexisting Conditions: Patient denies long-standing health conditions.
Allergies: Patient denies allergies to food or medications.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is under the age of 18 and received the vaccine. Patient denies any s/s, adverse affects and is aware of the situation.


Changed on 5/7/2021

VAERS ID: 951410 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2021-01-17
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / SYR

Administered by: Senior Living      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? 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: Patient denies prescriptions, OTC, herbal or dietary supplements.
Current Illness: Patient denies any illnesses one month prior to vaccination date.
Preexisting Conditions: Patient denies long-standing health conditions.
Allergies: Patient denies allergies to food or medications. medications.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is under the age of 18 and received the vaccine. Patient denies any s/s, adverse affects and is aware of the situation.


Changed on 5/21/2021

VAERS ID: 951410 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:South Carolina
Vaccinated:2021-01-17
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / SYR

Administered by: Senior Living      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? 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: Patient denies prescriptions, OTC, herbal or dietary supplements.
Current Illness: Patient denies any illnesses one month prior to vaccination date.
Preexisting Conditions: Patient denies long-standing health conditions.
Allergies: Patient denies allergies to food or medications. medications.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is under the age of 18 and received the vaccine. Patient denies any s/s, adverse affects and is aware of the situation.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=951410&WAYBACKHISTORY=ON


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