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

This is VAERS ID 1371624



Case Details

VAERS ID: 1371624 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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: none
Current Illness: no
Preexisting Conditions: iron deficiency
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was 17 at the time of administration.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371624


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