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This is VAERS ID 1152266

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First Appeared on 5/21/2021

VAERS ID: 1152266
VAERS Form:2
Location:North Dakota
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public      Purchased by: ??
Symptoms: Chills, Cough, Fatigue, Pulmonary congestion, Pyrexia, Product administered to patient of inappropriate age, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paroxetine and oral birth control (not sure which ones)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient was tested for covid on 3/22/21 and 3/25/21 due to viral illness she thinks she caught while working at daycare center. Her symptoms were chest congestion, cough with lots of phlegm and low grade temp. She was also tested for covid on 3/26/21 at a healthcare facility where she works. All 3 tests were negative.
CDC 'Split Type':

Write-up: 16 year old was vaccinated with Moderna on 3/11/21. Error was found on 3/26/21 by staff reviewing registration list for upcoming covid vaccine clinics. Spoke with patient and her mother on 3/30/21 to report what happened. Patient reported feeling very tired starting on the evening of 3/11/21 and continued until 3/12/21 around bedtime. Also had chills that started on 3/11/21 in the evening and lasted until 5pm on 3/12/21. Denies any other symptoms or problems.

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