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

This is VAERS ID 912401



Case Details

VAERS ID: 912401 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2020-12-29
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was under the age of 18 when Covid-19 vaccine was administered


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=912401


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