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

This is VAERS ID 1484490



Case Details

VAERS ID: 1484490 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-16
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 RA / IM

Administered by: Senior Living       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Was covid positive 46 days before vaccine
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Staff member is under the age of 18


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484490


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