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This is VAERS ID 953580

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 953580
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: the patient was 17 years old and 11 months when given the vaccine. this vaccine is approved for 18 years old and above. she did not have an adverse reaction.


Changed on 5/7/2021

VAERS ID: 953580 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: the patient was 17 years old and 11 months when given the vaccine. this vaccine is approved for 18 years old and above. she did not have an adverse reaction.


Changed on 5/21/2021

VAERS ID: 953580 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: the patient was 17 years old and 11 months when given the vaccine. this vaccine is approved for 18 years old and above. she did not have an adverse reaction.

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