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This is VAERS ID 1470536

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1470536
VAERS Form:2
Age:17.0
Sex:Male
Location:South Dakota
Vaccinated:2021-07-13
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site pain, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient, aged 17, was inappropriately given Moderna COVID19 vaccine, not recommended under the age of 18. Pharmacy attempted to contact patient immediately upon realization, roughly 3 hours after vaccination. Pharmacy finally reached patient''s mother the next morning, and she was informed of the error. Patient''s mother will monitor patient, and in accordance with CDC recommendation, the pharmacy will plan to administer the second dose of Moderna to the patient at the appropriate time. Patient''s mother agrees with this plan. At the time of contact, patient had only developed mild soreness at the injection site.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1470536&WAYBACKHISTORY=ON


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