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This is VAERS ID 951927

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951927
VAERS Form:2
Age:17.0
Sex:Female
Location:Alaska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20200

Write-up: Administered vaccine to 17 year old; A spontaneous report was received from a nurse concerning a 17 year old, female, patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, administered vaccine to a 17 year old. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The nurse reported the Moderna COVID vaccine was given to a 17 year old patient on an unknown date. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, administered vaccine to a 17 year old, was considered resolved.; Reporter''s Comments: This case concerns a 17-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product administered to patient of inappropriate age without any associated adverse events.


Changed on 5/7/2021

VAERS ID: 951927 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Alaska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20200

Write-up: Administered vaccine to 17 year old; A spontaneous report was received from a nurse concerning a 17 year old, female, patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, administered vaccine to a 17 year old. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The nurse reported the Moderna COVID vaccine was given to a 17 year old patient on an unknown date. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, administered vaccine to a 17 year old, was considered resolved.; Reporter''s Comments: This case concerns a 17-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product administered to patient of inappropriate age without any associated adverse events.


Changed on 5/21/2021

VAERS ID: 951927 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Alaska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20200

Write-up: Administered vaccine to 17 year old; A spontaneous report was received from a nurse concerning a 17 year old, female, patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, administered vaccine to a 17 year old. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The nurse reported the Moderna COVID vaccine was given to a 17 year old patient on an unknown date. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, administered vaccine to a 17 year old, was considered resolved.; Reporter''s Comments: This case concerns a 17-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product administered to patient of inappropriate age without any associated adverse events.

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