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

This is VAERS ID 935671

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Case Details

VAERS ID: 935671 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-01-08
Onset:2021-01-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 LA / IM

Administered by: Public       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? 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: Vaccine given to a 16 year old. No noted or reported adverse outcome. Vaccine clinic was held at clinic. Clinic was asked if any residents or staff was under 18 and they responded no. Patient turned out to be 16 and a staff worker. Administering RN did not catch the age and when it was entered in to database it flagged.


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