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))
        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: