National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 951957

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951957
VAERS Form:2
Age:16.0
Sex:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
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 medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Gave a 16 year old male a COVID-19 injection; A spontaneous report was received from a pharmacist concerning a 16-year-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, gave a 16-year-old male a COVID-19 injection. The patient''s medical history was not provided. No concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, a nurse gave a 16-year-old patient a COVID-19 injection. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, gave a 16-year-old male a COVID-19 injection, was considered resolved.; 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: 951957 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
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 medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Gave a 16 year old male a COVID-19 injection; A spontaneous report was received from a pharmacist concerning a 16-year-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, gave a 16-year-old male a COVID-19 injection. The patient''s medical history was not provided. No concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, a nurse gave a 16-year-old patient a COVID-19 injection. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, gave a 16-year-old male a COVID-19 injection, was considered resolved.; 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: 951957 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
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 medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Gave a 16 year old male a COVID-19 injection; A spontaneous report was received from a pharmacist concerning a 16-year-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event, gave a 16-year-old male a COVID-19 injection. The patient''s medical history was not provided. No concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, a nurse gave a 16-year-old patient a COVID-19 injection. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, gave a 16-year-old male a COVID-19 injection, was considered resolved.; 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.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=951957&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166