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From the 9/10/2021 release of VAERS data:

This is VAERS ID 910883



Case Details

VAERS ID: 910883 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025-J20-2A / 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: No
Allergies: None
Diagnostic Lab Data: No adverse event this is an administration error
CDC Split Type:

Write-up: Individual was under 18 years of age


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=910883


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