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This is VAERS ID 951958

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 951958
VAERS Form:2
Age:16.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / 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.MOD20210

Write-up: Vaccine administered to pediatric patient; A spontaneous report was received from a nurse concerning a 16 year old female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and vaccine was administered to a pediatric patient. The patient''s medical history was not provided. No relevant concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 (Lot #026L20A) on 31 Dec 2020, intramuscularly in the left arm, for prophylaxis of COVID-19 infection. On 31 Dec 2020, the Moderna vaccine was administered by error to a pediatric patient. The patient experiences no symptoms and was absolutely fine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine was administered to a pediatric patient, resolved on 31 Dec 2020.; Reporter''s Comments: This case concerns a 16-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot 026L20A), reporting Product administered to patient of inappropriate age without any associated adverse events.


Changed on 5/7/2021

VAERS ID: 951958 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / 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.MOD20210

Write-up: Vaccine administered to pediatric patient; A spontaneous report was received from a nurse concerning a 16 year old female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and vaccine was administered to a pediatric patient. The patient''s medical history was not provided. No relevant concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 (Lot #026L20A) on 31 Dec 2020, intramuscularly in the left arm, for prophylaxis of COVID-19 infection. On 31 Dec 2020, the Moderna vaccine was administered by error to a pediatric patient. The patient experiences no symptoms and was absolutely fine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine was administered to a pediatric patient, resolved on 31 Dec 2020.; Reporter''s Comments: This case concerns a 16-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot 026L20A), reporting Product administered to patient of inappropriate age without any associated adverse events.


Changed on 5/21/2021

VAERS ID: 951958 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / 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.MOD20210

Write-up: Vaccine administered to pediatric patient; A spontaneous report was received from a nurse concerning a 16 year old female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and vaccine was administered to a pediatric patient. The patient''s medical history was not provided. No relevant concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 (Lot #026L20A) on 31 Dec 2020, intramuscularly in the left arm, for prophylaxis of COVID-19 infection. On 31 Dec 2020, the Moderna vaccine was administered by error to a pediatric patient. The patient experiences no symptoms and was absolutely fine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine was administered to a pediatric patient, resolved on 31 Dec 2020.; Reporter''s Comments: This case concerns a 16-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot 026L20A), reporting Product administered to patient of inappropriate age without any associated adverse events.

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