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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1330690



Case Details

VAERS ID: 1330690 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Product administered to patient of inappropriate age
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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:
Current Illness:
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data: none required
CDC Split Type:

Write-up: administration error only, no side effects Moderna was inadvertently given by Nurse instead of Pfizer and the child is only 14 years of age she was educated about the vaccine that was given, provided materials, kept for monitoring for 30 minutes. provided with public health nurse contact info. no adverse reaction observed, reported, or noted aside from minor redness at injection site after 30 minutes. child was released home with grandmother who is her legal guardian. Contacted department of health who advised us to complete this vaers report but to go ahead and have them come back for her second dose of moderna after 28 days


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