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This is VAERS ID 945030

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 945030
VAERS Form:2
Age:15.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011520A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given Moderna vaccine at 15 years old accidentally, which is less than the minimum age in the EUA. Patient was supposed to receive Pfizer vaccine, although he still would have been too young for that as well. Patient is a volunteer at hospital where this occurred. There were no adverse effects other them arm soreness


Changed on 5/7/2021

VAERS ID: 945030 Before After
VAERS Form:2
Age:15.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011520A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given Moderna vaccine at 15 years old accidentally, which is less than the minimum age in the EUA. Patient was supposed to receive Pfizer vaccine, although he still would have been too young for that as well. Patient is a volunteer at hospital where this occurred. There were no adverse effects other them arm soreness


Changed on 5/21/2021

VAERS ID: 945030 Before After
VAERS Form:2
Age:15.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-01-10
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011520A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given Moderna vaccine at 15 years old accidentally, which is less than the minimum age in the EUA. Patient was supposed to receive Pfizer vaccine, although he still would have been too young for that as well. Patient is a volunteer at hospital where this occurred. There were no adverse effects other them arm soreness

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=945030&WAYBACKHISTORY=ON


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