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From the 1/7/2022 release of VAERS data:

This is VAERS ID 945029

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Case Details

VAERS ID: 945029 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Public       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Heart Disease
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: The patient is 16 years old and received the Moderna vaccine. The patient''s mother was contacted immediately after this event was noted approximately 30 minutes after the patient received the vaccination. The mother verbalizes knowing that they were aware of the age requirement but felt due to his physical built of 200lbs and that he should be able to receive the vaccine. The patient not experiencing any adverse reactions as of the last phone call inquiry by this nurse at 4:20 pm. Mother was instructed to seek medical attention for any adverse reactions, she verbalized understanding. Follow up call will be placed to the mother tomorrow,


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