VAERS ID: 2039188

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

Description

No adverse event, administration error. Patient requested Moderna booster after her Pfizer series but is not old enough to get Moderna. Administering pharmacist did not catch she was too young until after the shot was administered.

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

No adverse event, Interchange of vaccine products, Product administered to patient of inappropriate age, Product administration error

Vaccines

VAX DATE: 01-14-2022| ONSET DATE: 01-14-2022| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 001J212A IM Unknown

RECVDATE:01-17-2022
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-17-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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