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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1068752

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Case Details

VAERS ID: 1068752 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-25
Onset:2021-01-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L29A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Product administered to patient of inappropriate age, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Bruised arm; Itchy; Accidental administration of the Moderna COVID-19 Vaccine to a patient who is 15 years old; A spontaneous report ( was received from a pharmacist concerning a 15-year-old, female patient to who accidently received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced accidental administration of the Moderna COVID-19 vaccine to a patient who is 15 years old/product administered to patient of inappropriate age, itchy/pruritus and bruised arm/contusion. The patient''s medical history was not provided. No concomitant product use was reported. On 25 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 012L29A) in the right arm intramuscularly for prophylaxis of COVID-19 infection. On 25 Jan 2021, a 15-year-old female patient received an accidental dose of the Moderna COVID-19 vaccine and experienced an itchy arm. On 28 Jan 2021, the reporter noted the patient had a bruised arm. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the event, accidental administration of the Moderna COVID-19 Vaccine to a patient who is 15 years old/product administered to patient of inappropriate age, was considered resolved on 25 Jan 2021. The outcome of the events, itchy and bruised arm, were considered unknown.; Reporter''s Comments: This report refers to a case of Product administered to patient of inappropriate age for mRNA-1273, lot # 12L29A, with associated AEs. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


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