VAERS ID: 910883

AGE: 15| SEX: M|STATE: CO (United States)

Description

Individual was under 18 years of age

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, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 12-22-2020| ONSET DATE: 12-22-2020| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 025-J20-2A IM LA

RECVDATE:12-28-2020
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:No adverse event this is an administration error
V_ADMINBY:OTH
OTHER_MEDS:None
CUR_ILL:None
HISTORY:No
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-28-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:None
V_FUNDBY:

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OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.