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VAERS ID: 1627979

AGE: 17| SEX: F|State: NE

Description

Pt is 17 years old and was given a first dose of Moderna vaccine at the pharmacy, she presented for her second dose to a clinic at which time the mistake was identified. A second dose of Moderna was administered on 8-18-21 per recommendation from CDC when 1st dose is given to an underage person by mistake.

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 20 July 2021 | ONSET DATE: 20 July 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))
  • 1

RECVDATE:23 August 2021
CAGE_YR:17
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:unknown
CUR_ILL:unknown
HISTORY:unknown
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:23 August 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:unknown
V_FUNDBY:
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