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

This is VAERS ID 1424107



Case Details

VAERS ID: 1424107 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM

Administered by: Work       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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 17 year old patient received 1st dose of the Moderna vaccine at a previous clinic on 5/7/2021 despite the vaccine only being approved for use in patients 18 years and older. Based on CDC guidance and information from the manufacturer it was recommended to vaccinate patient with a second dose of the Moderna vaccine and follow the vaccine dosing schedule. No adverse effects were reported from the patient.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1424107


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