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From the 10/8/2021 release of VAERS data:

This is VAERS ID 915958



Case Details

VAERS ID: 915958 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / SC

Administered by: Public       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:
Preexisting Conditions: asthma (reported by mother- denied by child)
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: During Covid Clinic, 17 year old was given Moderna vaccine approved for age 18 and older, Screening In system does not alert to age. Age not noted during screening. No adverse reation noted following Injection. Telephone call to mother on 12/31/20 twice with no response. Voice mail left to check status of child and request return call..


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=915958

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