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VAERS ID: 1464766

AGE: 15| SEX: F|State: IA

Description

no adverse reaction; just given (mistakenly) to an individual that was not 18 at time of vaccine

Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 06 July 2021 | ONSET DATE: 06 July 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))
  • UNK
  • IM
  • LA
  • 038C21A

RECVDATE:11 July 2021
CAGE_YR:15
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:U
LAB_DATA:none
V_ADMINBY:PVT
OTHER_MEDS:diclofenac, pristiq
CUR_ILL:none
HISTORY:depression/anxiety
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:11 July 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:none
V_FUNDBY:
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