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This is VAERS ID 951780

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951780
VAERS Form:2
Age:15.0
Sex:Male
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: A 6 foot adult appearing male, received the Moderna vaccine. The afternoon of his vaccination we recognized the patient was 15 years old. We immediately called the mother. The child had been completely asymptomatic four hours after receiving the vaccine. The following morning the patient continued to have no symptoms, as we communicated with the Mother.


Changed on 5/7/2021

VAERS ID: 951780 Before After
VAERS Form:2
Age:15.0
Sex:Male
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: A 6 foot adult appearing male, received the Moderna vaccine. The afternoon of his vaccination we recognized the patient was 15 years old. We immediately called the mother. The child had been completely asymptomatic four hours after receiving the vaccine. The following morning the patient continued to have no symptoms, as we communicated with the Mother.


Changed on 5/21/2021

VAERS ID: 951780 Before After
VAERS Form:2
Age:15.0
Sex:Male
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: A 6 foot adult appearing male, received the Moderna vaccine. The afternoon of his vaccination we recognized the patient was 15 years old. We immediately called the mother. The child had been completely asymptomatic four hours after receiving the vaccine. The following morning the patient continued to have no symptoms, as we communicated with the Mother.

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