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

This is VAERS ID 945362

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Case Details

VAERS ID: 945362 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-13
Onset:2021-01-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MODERNA COVID-19 VACCINE EUA HOSPITAL CONTRACT EMPLOYEE (AGE 17) WAS SCHEDULED, AND SUBSEQUENTLY WAS ADMINISTERED THE MODERNA COVID-19 VACCINE. NO ADVERSE REACTION NOTED TO VACCINE, BUT ADMINISTRATION ERROR DUE TO AGE OF PATIENT.


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