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This is VAERS ID 951750

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951750
VAERS Form:2
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / 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? 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: Unknown
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient received a Moderna COVID19 Vaccine.


Changed on 5/7/2021

VAERS ID: 951750 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / 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? 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: Unknown
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient received a Moderna COVID19 Vaccine.


Changed on 5/21/2021

VAERS ID: 951750 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / 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? 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: Unknown
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient received a Moderna COVID19 Vaccine.

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