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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1736221

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Case Details

VAERS ID: 1736221 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-26
Onset:2021-08-31
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003659 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Injection site reaction, Lymphadenopathy, Skin disorder
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20213

Write-up: This case was received via regulatory authority (Reference number: BE-FAMHP-DHH-N2021-106305) on 17-Sep-2021 and was forwarded to Moderna on 17-Sep-2021. This regulatory authority case was reported by a physician and describes the occurrence of ERYTHEMA, SKIN DISORDER, INJECTION SITE REACTION and LYMPHADENOPATHY in a 13-year-old male patient who received mRNA-1273 (Spikevax) (batch no. 3003659) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 31-Aug-2021, the patient experienced ERYTHEMA, SKIN DISORDER, INJECTION SITE REACTION and LYMPHADENOPATHY. At the time of the report, ERYTHEMA, SKIN DISORDER, INJECTION SITE REACTION and LYMPHADENOPATHY outcome was unknown. For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments. Concomitant medication was not provided. Treatment information was not provided. Most recent FOLLOW-UP information incorporated above includes: On 17-Sep-2021: The translation document received contains no new information.


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