VAERS ID: 2327614

AGE: 14| SEX: F|STATE: CA

Description

Patient came into our clinic and she had the primary series of Moderna in "private". She came for her booster with her parent who requested Moderna to complete the series. She was given the booster dose of 0.25mL and it was then identified that she was only 14 years old and not eligible for this vaccine. We will input the patient into system directly, since Moderna will not populate. We have also reeducated the vaccinating nurse and referenced the binders on site that have all the vaccine doses information, as well as provided remediation training and testing. Patient was monitored for 30 minutes and reported no side effects from the vaccine.

Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 06-22-2022| ONSET DATE: 06-22-2022| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 3 COVID19 MODERNA 038A22A IM LA

RECVDATE:06-22-2022
RPT_DATE:
CAGE_YR:14
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:No
CUR_ILL:No
HISTORY:No
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:06-22-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:No
V_FUNDBY:

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