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This is VAERS ID 953725

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 953725
VAERS Form:2
Age:17.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

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? 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: Vaccine administered to individual < 18 years old She exhibited no adverse reactions within 30 minutes post-vaccine. She was given VSAFE information to report any delayed reactions/AE''s.


Changed on 5/7/2021

VAERS ID: 953725 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

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? 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: Vaccine administered to individual < 18 years old She exhibited no adverse reactions within 30 minutes post-vaccine. She was given VSAFE information to report any delayed reactions/AE''s.


Changed on 5/21/2021

VAERS ID: 953725 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-16
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

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? 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: Vaccine administered to individual < 18 years old She exhibited no adverse reactions within 30 minutes post-vaccine. She was given VSAFE information to report any delayed reactions/AE''s.

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