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From the 11/19/2021 release of VAERS data:

Found 27,648 cases where Age is 6-or-more-and-under-18 and Vaccine is COVID19

Government Disclaimer on use of this data



Case Details

This is page 18 out of 2,765

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VAERS ID: 953901 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-15
Onset:2021-01-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient incorrectly indicated age on authorization form - indicated birthdate in 2002 and age not under 18. Shot given. Patient with no known adverse effects at this time.


VAERS ID: 953954 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-18
Onset:2021-01-18
   Days after vaccination:0
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
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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)


VAERS ID: 954011 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Estradiol, Clobetasol
Current Illness: None
Preexisting Conditions: Anxiety, Aphthous Stomatitis, Eczema
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient is under the age of 18 and should not have received the vaccine


VAERS ID: 954211 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-14
Onset:2021-01-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Nasal pruritus, Rhinorrhoea
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Runny and itchy nose, lasting for about a day.


VAERS ID: 954301 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-19
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
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: 16 year old male child received the first Moderna vaccine; A spontaneous report was received from a consumer concerning a 16-year-old, male patient, who received Moderna''s COVID-19 Vaccine (mRNA-1273) resulting in the event, 16 year old male child received the first Moderna vaccine. The patient''s medical history was not provided. Concomitant medications were not reported. On 30 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 30 Dec 2020, the patient was 16 years of age when he received the mRNA-1273 vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of event, 16 year old male child received the first Moderna vaccine, was considered resolved on 30 Dec 2020.; Reporter''s Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of product administered to patient of inappropriate age.


VAERS ID: 955014 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was given to person under the age of 18. Screening measures have been reinforced to prevent continued vaccination under the age established .


VAERS ID: 955312 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-11
Onset:2021-01-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: This individual is an EMS first responder who volunteers within our EMS system. She arrived at our clinic during a event to receive a vaccination. Unfortunately, she was advised that she could receive a vaccine with her mothers consent by our County Emergency Manager. A consent was obtained and she was lead to the clinic injection area. Once there, her consent form was reviewed and all of her screening questions were checked no. At this point in time, on the first day, we did not include a yes/no question confirming everyone was over 18 because its was only select recipients. The mistake was noticed immediatly and reported to the recipients mother who was also on site. It was explained the vaccine administered does not have an EUA for 16-18 year-olds. The county OMD was also notified at this time. The recipient did not have any reactions post inoculation. A followup call was placed later in the day to confirm she still did not experience any signs or symptoms, which she had not. We where able to identify the root cause of this event and have implemented a number of new safety measures to ensure we do not have a repeat event.


VAERS ID: 955465 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-27
Onset:2021-01-19
   Days after vaccination:23
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
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was 17 years old. Vaccine is authorized for 18 and older. No adverse reaction reported.


VAERS ID: 955479 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-10
Onset:2021-01-19
   Days after vaccination:9
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
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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.


VAERS ID: 955504 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-17
Onset:2021-01-19
   Days after vaccination:2
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
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error. Patient was 16 when vaccine was administered. It''s authorized for 18 and older. No known adverse events.


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