|
VAERS ID: |
905644 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: |
2020-12-21 |
Onset: |
2020-12-21 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 4 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Throat irritation SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? No ER or Doctor Visit? Yes Hospitalized? No Previous Vaccinations: Other Medications: Methylphenidate ER, monodox, celexa, ventolin Current Illness: none Preexisting Conditions: ADHD, anxiety Allergies: NKA Diagnostic Lab Data: none CDC Split Type: Write-up: "felt like throat scratching" |
|
VAERS ID: |
907181 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: |
2020-12-21 |
Onset: |
2020-12-23 |
Days after vaccination: |
2 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Arthralgia, Chills, Fatigue, Hypoaesthesia, Pain in extremity, Paraesthesia, Pyrexia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Birth Control Current Illness: Streptococcus Preexisting Conditions: Obesity Allergies: perfumes and soaps Diagnostic Lab Data: CDC Split Type: Write-up: Extreme arm pain alternating with numbness and tingling, joint pain in shoulder, elbow, and wrist, chills, low grade fever (100.5), fatigue |
|
VAERS ID: |
907882 (history) |
Form: |
Version 2.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
Iowa |
Vaccinated: |
2020-12-21 |
Onset: |
2020-12-21 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / IM |
Administered by: Pharmacy 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: Sertraline, Metformin ER, Tri-Linyah Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: THERE WAS NO ADVERSE EVENT. We realized after administration that we had inadvertently given the vaccine to a 15 year old girl. She is not having any symptoms or problems. We have been monitoring her and encouraged her to speak with us if she has any issues at all. |
|
VAERS ID: |
908624 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
2020-12-23 |
Onset: |
2020-12-23 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
RA / 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: 000067-TVFC Write-up: No adverse event reported. Found in paperwork that this person was only 16 years of age and should not have received Moderna Vaccine. |
|
VAERS ID: |
909410 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: |
2020-12-24 |
Onset: |
2020-12-24 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K20A / 1 |
LA / IM |
Administered by: Unknown 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? 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: 000067 Write-up: Client is 17 year old and vaccine given. Unknown adverse reaction. Underage for vaccine approved. |
|
VAERS ID: |
910883 (history) |
Form: |
Version 2.0 |
Age: |
15.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: |
2020-12-22 |
Onset: |
2020-12-22 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025-J20-2A / 1 |
LA / IM |
Administered by: Other 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: None Current Illness: None Preexisting Conditions: No Allergies: None Diagnostic Lab Data: No adverse event this is an administration error CDC Split Type: Write-up: Individual was under 18 years of age |
|
VAERS ID: |
911988 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: |
2020-12-23 |
Onset: |
2020-12-23 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
039K2019 / 1 |
AR / 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? Yes 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: Moderna has an EUA from the FDA for patients aged 18 and older. This vaccine was used inappropriately to vaccinate a 17 year old staff member at a clinic hosted by Pharmacy. Patient experienced no adverse effects, but this improper usage of the vaccination requires reporting to VAERS. |
|
VAERS ID: |
912103 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: |
2020-12-28 |
Onset: |
2020-12-28 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / UNK |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Abnormal behaviour, Dizziness, Nausea SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Vestibular disorders (broad) 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: Cryselle 1 tab orally once daily Fluoxetine 20 mg orally once daily Current Illness: Preexisting Conditions: Anxiety, depression, menorrhagia, family hx of Marfan syndrome Allergies: Amoxicillin Diagnostic Lab Data: CDC Split Type: Write-up: Dizziness and nausea 10 minutes after injection, continued to wax and wane over approx 90 minutes. No vitals taken. Patient ambulated back to work at 1800. |
|
VAERS ID: |
912401 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
North Dakota |
Vaccinated: |
2020-12-29 |
Onset: |
0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025J20-2A / 1 |
RA / 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? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: unknown Current Illness: unknown Preexisting Conditions: unknown Allergies: unknown Diagnostic Lab Data: none CDC Split Type: Write-up: Patient was under the age of 18 when Covid-19 vaccine was administered |
|
VAERS ID: |
913129 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Alaska |
Vaccinated: |
2020-12-29 |
Onset: |
2020-12-29 |
Days after vaccination: |
0 |
Submitted: |
0000-00-00 |
Entered: |
2020-12-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011J20A / 1 |
LA / IM |
Administered by: Public 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? Yes Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: No known allergies Diagnostic Lab Data: n/a CDC Split Type: Write-up: patient was 17 years old at time of administration, vaccine only approved for 18 and older |
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