VAERS ID: 1152345

AGE: 17| SEX: F|STATE: TX

Description

A 17 year old patient was given the COVID Moderna vaccine. The COVID Moderna is licensed for 18 years of age and older.

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 03-31-2021| ONSET DATE: 03-31-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA ER8727 IM LA

RECVDATE:03-31-2021
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:U
LAB_DATA:
V_ADMINBY:MIL
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:03-31-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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