return to results page

VAERS ID: 1505277

AGE: 15| SEX: F|State: MO

Description

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.

Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 25 July 2021 | ONSET DATE: 25 July 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))
  • 1
  • IM
  • LA
  • 026C21A

RECVDATE:26 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 ordered as it was not clinically indicated at this time.
V_ADMINBY:PUB
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
V_FUNDBY:
return to results page

Questions? Comments? Bugs?
[email protected]
Due to the high volume of inquiries, please be patient with response times.

AND PLEASE read the FAQ first.

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