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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1232041



Case Details

VAERS ID: 1232041 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-03-14
Onset:2021-04-11
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: MODERN 0.5 ML FOR IM LOT 020B21A EPX:09/23/2021 No known adverse events.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1232041


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