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This is VAERS ID 951902

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951902
VAERS Form:2
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: 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: Administered vaccine to 17 year old patient; A spontaneous report was received from a nurse concerning a 17-year-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, administered vaccine to 17 year old patient. The patient''s medical history was not provided. Concomitant medications were not reported. On 30 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 31 Dec 220, the nurse reported the 17-year-old vaccinated patient did not have any symptoms that they knew of. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, administered vaccine to 17 year old patient, was considered resolved on 30 Dec 2020.; Reporter''s Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of product administered to patient of inappropriate age.


Changed on 5/7/2021

VAERS ID: 951902 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: 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: Administered vaccine to 17 year old patient; A spontaneous report was received from a nurse concerning a 17-year-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, administered vaccine to 17 year old patient. The patient''s medical history was not provided. Concomitant medications were not reported. On 30 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 31 Dec 220, the nurse reported the 17-year-old vaccinated patient did not have any symptoms that they knew of. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, administered vaccine to 17 year old patient, was considered resolved on 30 Dec 2020.; Reporter''s Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of product administered to patient of inappropriate age.


Changed on 5/21/2021

VAERS ID: 951902 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Pennsylvania
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: 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: Administered vaccine to 17 year old patient; A spontaneous report was received from a nurse concerning a 17-year-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, administered vaccine to 17 year old patient. The patient''s medical history was not provided. Concomitant medications were not reported. On 30 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 31 Dec 220, the nurse reported the 17-year-old vaccinated patient did not have any symptoms that they knew of. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, administered vaccine to 17 year old patient, was considered resolved on 30 Dec 2020.; Reporter''s Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of product administered to patient of inappropriate age.

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