VAERS ID: 912401

AGE: 17| SEX: M|STATE: ND (United States)

Description

Patient was under the age of 18 when Covid-19 vaccine was administered

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(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

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 12-29-2020| ONSET DATE: | DAYS TO ONSET:
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 025J20-2A IM RA

RECVDATE:12-29-2020
RPT_DATE:
CAGE_YR:17
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:none
V_ADMINBY:PVT
OTHER_MEDS:unknown
CUR_ILL:unknown
HISTORY:unknown
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-29-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:unknown
V_FUNDBY:

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