Adverse Event Reporting

VAERS ID 1901365
Gender Male
Age 12
StateCode NY
Pharmaceutical Company MODERNA
Lot Number 939904
Number of vaccinations 1
Vaccinated 2021-11-19
Onset 2021-11-19
Condition Recovered
Symptoms
  • Product administered to patient of inappropriate age

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

12 year old received Moderna vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old received Moderna vaccine) in a 12-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no.
939904) for COVID-19 vaccination.
No Medical History information was reported.
On 19-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form.
On 19-Nov-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old received Moderna vaccine).
On 19-Nov-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old received Moderna vaccine) had resolved.
For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.
No Concomitant and Treatment medication were reported.
A 12-year-old patient received the first dose of Moderna COVID-19 vaccine on 19NOV2021 (Lot# 939904 & Exp.
Date: 24MAR2022 ) instead of Pfizer.