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This is VAERS ID 945774

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 945774
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / OT

Administered by: Unknown      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: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20200

Write-up: 17-Year-old patient was vaccinated; Sore arm; A spontaneous report was received from a nurse concerning a 17-year-old female patient who received Moderna''s COVID-19 Vaccine and experienced sore arm and 17-year-old patient was vaccinated. The patient''s medical history was not provided. No relevant concomitant medications were reported. On 30 Dec 2020, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 026L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. The vaccine was administered at a University''s campus. On 30 Dec 2020, the patient, a medical assistant, received the vaccine and did not inform the vaccinator of her age until after the vaccine was given. The patient experienced a sore arm after receiving the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, 17-year-old patient was vaccinated, was resolved on 30 Dec 2020. The outcome of the event, sore arm, was unknown.; Reporter''s Comments: This case concerns a 17 year old, female, patient. The patient''s medical history is not provided. The event occurred on 30 Dec 2020 during administration of the first dose of the mRNA-1273, lot # 026L20A. This report refers to an unexpected event of administration of mRNA-1273 to patient of inappropriate age (17 year old). The patient had an expected event of pain in arm during the injection. The sponsor considered the event of vaccine administration to patient of inappropriate age as not related to mRNA-1273. The event of pain in arm is related to mRNA-1273 as ''pain at the site of injection'' is the listed event on the company''s fact sheet for the healthcare providers.


Changed on 5/7/2021

VAERS ID: 945774 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / OT

Administered by: Unknown      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: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20200

Write-up: 17-Year-old patient was vaccinated; Sore arm; A spontaneous report was received from a nurse concerning a 17-year-old female patient who received Moderna''s COVID-19 Vaccine and experienced sore arm and 17-year-old patient was vaccinated. The patient''s medical history was not provided. No relevant concomitant medications were reported. On 30 Dec 2020, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 026L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. The vaccine was administered at a University''s campus. On 30 Dec 2020, the patient, a medical assistant, received the vaccine and did not inform the vaccinator of her age until after the vaccine was given. The patient experienced a sore arm after receiving the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, 17-year-old patient was vaccinated, was resolved on 30 Dec 2020. The outcome of the event, sore arm, was unknown.; Reporter''s Comments: This case concerns a 17 year old, female, patient. The patient''s medical history is not provided. The event occurred on 30 Dec 2020 during administration of the first dose of the mRNA-1273, lot # 026L20A. This report refers to an unexpected event of administration of mRNA-1273 to patient of inappropriate age (17 year old). The patient had an expected event of pain in arm during the injection. The sponsor considered the event of vaccine administration to patient of inappropriate age as not related to mRNA-1273. The event of pain in arm is related to mRNA-1273 as ''pain at the site of injection'' is the listed event on the company''s fact sheet for the healthcare providers.


Changed on 5/21/2021

VAERS ID: 945774 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / OT

Administered by: Unknown      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: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20200

Write-up: 17-Year-old patient was vaccinated; Sore arm; A spontaneous report was received from a nurse concerning a 17-year-old female patient who received Moderna''s COVID-19 Vaccine and experienced sore arm and 17-year-old patient was vaccinated. The patient''s medical history was not provided. No relevant concomitant medications were reported. On 30 Dec 2020, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 026L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. The vaccine was administered at a University''s campus. On 30 Dec 2020, the patient, a medical assistant, received the vaccine and did not inform the vaccinator of her age until after the vaccine was given. The patient experienced a sore arm after receiving the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, 17-year-old patient was vaccinated, was resolved on 30 Dec 2020. The outcome of the event, sore arm, was unknown.; Reporter''s Comments: This case concerns a 17 year old, female, patient. The patient''s medical history is not provided. The event occurred on 30 Dec 2020 during administration of the first dose of the mRNA-1273, lot # 026L20A. This report refers to an unexpected event of administration of mRNA-1273 to patient of inappropriate age (17 year old). The patient had an expected event of pain in arm during the injection. The sponsor considered the event of vaccine administration to patient of inappropriate age as not related to mRNA-1273. The event of pain in arm is related to mRNA-1273 as ''pain at the site of injection'' is the listed event on the company''s fact sheet for the healthcare providers.

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