VAERS ID: 1505277

AGE: 15| SEX: F|STATE: MO (United States)

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.

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Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 07-26-2021| ONSET DATE: 07-26-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 026c21a IM LA

RECVDATE:07-27-2021
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
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:
TODAYS_DATE:07-27-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:none reported
V_FUNDBY:

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