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

This is VAERS ID 951410

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Case Details

VAERS ID: 951410 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-01-17
Onset:2021-01-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / SYR

Administered by: Senior Living       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denies prescriptions, OTC, herbal or dietary supplements.
Current Illness: Patient denies any illnesses one month prior to vaccination date.
Preexisting Conditions: Patient denies long-standing health conditions.
Allergies: Patient denies allergies to food or medications.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is under the age of 18 and received the vaccine. Patient denies any s/s, adverse affects and is aware of the situation.


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