VAERS ID: 1087666

AGE: 17| SEX: M|STATE: NY

Description

Client received first dose of Moderna Vaccine. Consent signed by the client's mother. Per manufacturer's guidelines, client was not eligible for the vaccine due to being under the age of 18. Dr. notified Moderna and the Center for Disease Control and Prevention (CDC) of the incident. Parents were notified that the first dose that was given to the child was not in accordance with the CDC and manufacturer's guidelines. They were also informed that the CDC and Moderna were notified of the incident and that the CDC has allowed the second dose series to be administered to children 16 years and older in similar situations. The parent/guardian was given the option to return to the clinic at the scheduled interval and for their child to receive the second dose series to provide better protection against the COVID-19 infection.

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 01-29-2021| ONSET DATE: 01-29-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 012M20A IM LA

RECVDATE:03-10-2021
RPT_DATE:
CAGE_YR:17
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:none
V_ADMINBY:PUB
OTHER_MEDS:none noted
CUR_ILL:none noted
HISTORY:none noted
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:03-10-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:none listed
V_FUNDBY:

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