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

This is VAERS ID 925174

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Case Details

VAERS ID: 925174 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-06
Onset:2021-01-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L2A / 1 LA / -

Administered by: Private       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: Proair Flovent
Current Illness:
Preexisting Conditions: Asthma
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No reported adverse reaction...Just that patient was given Moderna and is < 18 yrs of age.


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