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From the 1/7/2022 release of VAERS data:

This is VAERS ID 932973

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Case Details

VAERS ID: 932973 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-09
Onset:2021-01-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, No adverse event, Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: on 1/9/2021 -, 16 year old female was given Moderna vaccine. 10 minutes after injection, this was discovered. Pt reports no adverse reactions during the 15 minute observation period. Telephone call on 1/10/2021 at 3:00 pm mother reports child had some arm soreness and a little dizzy yesterday but today feels fine.


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