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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1365962



Case Details

VAERS ID: 1365962 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Non
Current Illness: Non
Preexisting Conditions: Non
Allergies: Non
Diagnostic Lab Data: non
CDC Split Type:

Write-up: No adverse event. The only issue of concern is that, the patient was less than the 18 years threshold to qualify for the above vaccine.


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