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This is VAERS ID 955479

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 955479
VAERS Form:2
Age:17.0
Sex:Female
Location:New York
Vaccinated:2021-01-10
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Other      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: Administration error - patient was 17 years when vaccine was administered. Vaccine is authorized for use in 18 and older. No know adverse events.


Changed on 5/7/2021

VAERS ID: 955479 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:New York
Vaccinated:2021-01-10
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Other      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: Administration error - patient was 17 years when vaccine was administered. Vaccine is authorized for use in 18 and older. No know adverse events.


Changed on 5/21/2021

VAERS ID: 955479 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:New York
Vaccinated:2021-01-10
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Other      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: Administration error - patient was 17 years when vaccine was administered. Vaccine is authorized for use in 18 and older. No know adverse events.

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