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VAERS ID: 1904188

AGE: 17| SEX: M|State: WA

Description

Gave the first dose of Moderna Vaccine to a patient 17.5 years old , not officially 18 and over

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 26 November 2021 | ONSET DATE: 26 November 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))
  • 1
  • IM
  • LA
  • 039F21A

RECVDATE:26 November 2021
CAGE_YR:17
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:U
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:N/A
CUR_ILL:N/A
HISTORY:N/A
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:26 November 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:N/A
V_FUNDBY:
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