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This is VAERS ID 953954

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 953954
VAERS Form:2
Age:16.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

Administered by: Senior Living      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: Patient was monitored for 15 minutes post vaccination and no adverse reactions reported. The error was discovered upon return of VAR to pharmacy (patient is 16 years old and it was outside of age range for Moderna)


Changed on 5/7/2021

VAERS ID: 953954 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

Administered by: Senior Living      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: Patient was monitored for 15 minutes post vaccination and no adverse reactions reported. The error was discovered upon return of VAR to pharmacy (patient is 16 years old and it was outside of age range for Moderna)


Changed on 5/21/2021

VAERS ID: 953954 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

Administered by: Senior Living      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: Patient was monitored for 15 minutes post vaccination and no adverse reactions reported. The error was discovered upon return of VAR to pharmacy (patient is 16 years old and it was outside of age range for Moderna)

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=953954&WAYBACKHISTORY=ON


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