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

This is VAERS ID 926987

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Case Details

VAERS ID: 926987 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Outpatient Medications at End of Encounter on as of 8/4/2020 Disp Refills Start End Carbamide Peroxide (DEBROX) 6.5 % Otic Drop 15 1/1 11/25/2019 Sig - Route: USE AS DIRECTED 7 drop once day for 7 �min for 5 �days prior to ear cleaning -
Current Illness: as of 8/4/2020 ICD-10-CM Priority Class Noted - Resolved ECZEMA L30.9 8/2/2013 - Present CONGENITAL BILAT FLAT FOOT Q66.51, Q66.52 8/15/2016 - Present
Preexisting Conditions: n/a
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administered vaccine to a 16yr old


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