VAERS ID: 1159442

AGE: 17| SEX: M|STATE: NJ (United States)

Description

underage male vaccinated

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 01-23-2004| ONSET DATE: 03-30-2021| DAYS TO ONSET: 6276
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 018B21A IM LA

RECVDATE:04-02-2021
RPT_DATE:
CAGE_YR:0
CAGE_MO:0
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PUB
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:04-02-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.