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This is VAERS ID 954301

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 954301
VAERS Form:2
Age:16.0
Sex:Male
Location:New Mexico
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-19
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
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: 16 year old male child received the first Moderna vaccine; A spontaneous report was received from a consumer concerning a 16-year-old, male patient, who received Moderna''s COVID-19 Vaccine (mRNA-1273) resulting in the event, 16 year old male child received the first Moderna vaccine. 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 30 Dec 2020, the patient was 16 years of age when he received the mRNA-1273 vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of event, 16 year old male child received the first Moderna vaccine, 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: 954301 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:New Mexico
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-19
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
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: 16 year old male child received the first Moderna vaccine; A spontaneous report was received from a consumer concerning a 16-year-old, male patient, who received Moderna''s COVID-19 Vaccine (mRNA-1273) resulting in the event, 16 year old male child received the first Moderna vaccine. 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 30 Dec 2020, the patient was 16 years of age when he received the mRNA-1273 vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of event, 16 year old male child received the first Moderna vaccine, 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: 954301 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:New Mexico
Vaccinated:2020-12-30
Onset:2020-12-30
Submitted:0000-00-00
Entered:2021-01-19
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
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: 16 year old male child received the first Moderna vaccine; A spontaneous report was received from a consumer concerning a 16-year-old, male patient, who received Moderna''s COVID-19 Vaccine (mRNA-1273) resulting in the event, 16 year old male child received the first Moderna vaccine. 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 30 Dec 2020, the patient was 16 years of age when he received the mRNA-1273 vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of event, 16 year old male child received the first Moderna vaccine, 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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