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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1368183



Case Details

VAERS ID: 1368183 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C54C21A / 1 LA / IM

Administered by: Private       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: None
Current Illness: none
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/1 moderna vaccine- No reactions
CDC Split Type:

Write-up: Patient received Moderna vaccination and he is currently 17 years which has not been approved yet for his age. I did call back this morning to follow up with patient but I let a VM to callback for update on how he is feeling.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368183


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