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This is VAERS ID 1328239

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1328239
VAERS Form:2
Age:17.0
Sex:Female
Location:Texas
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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:
Current Illness: no illnesses
Preexisting Conditions: zero Moderna vaccine accidentally given to patient under the age of 18. No adverse effects noticed. Is it possible for patient to be given second Moderna vaccine at 28 days, or will she have to wait until her 18th birthday? Patient is tall and athletic. Please contact, pharmacist at the pharmacy Phone number listed. Her birthday is on a date and she starts college and will be playing two sports. Her mother is very concerned that she could have adverse effects right before she starts college. Is it possible to give her a waiver? Thank you R.Ph
Allergies: shellfish
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: No adverse effects ?.. Moderna accidentally given to patient under the age of 18....see previous description of event.

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