1505277

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No adverse event, Product administered to patient of inappropriate age
VAERS_ID:
1505277
CATEGORY:
2021
RECVDATE:
26 July 2021
STATE:
MO
AGE_YRS:
15.00
CAGE_YR:
15
CAGE_MO:
SEX:
F
RPT_DATE:
SYMPTOM_TEXT:
Patient is a 15 year old female that received the Moderna COVID vaccine. After vaccination, event was reported. Dr. called father to report incident. Father did not report any adverse effects at this time. Father instructed to go to ER if patient starts showing any signs or symptoms of a reaction to the vaccine.
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
U
VAX_DATE:
25 July 2021
ONSET_DATE:
25 July 2021
NUMDAYS:
0
LAB_DATA:
None ordered as it was not clinically indicated at this time.
V_ADMINBY:
PUB
V_FUNDBY:
OTHER_MEDS:
none reported
CUR_ILL:
none reported
HISTORY:
none reported
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
26 July 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
none reported
VAX_TYPE:
COVID19
VAX_MANU:
MODERNA
VAX_LOT:
026C21A
VAX_DOSE_SERIES:
1
VAX_ROUTE:
IM
VAX_SITE:
LA
VAX_NAME:
COVID19 (COVID19 (MODERNA))