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You are viewing patients aged: 17, in state: MD

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VAERS_ID	RECVDATE	STATE	AGE_YRS	CAGE_YR	CAGE_MO	SEX	RPT_DATE	SYMPTOM_TEXT	DIED	DATEDIED	L_THREAT	ER_VISIT	HOSPITAL	HOSPDAYS	X_STAY	DISABLE	RECOVD	VAX_DATE	ONSET_DATE	NUMDAYS	LAB_DATA	V_ADMINBY	V_FUNDBY	OTHER_MEDS	CUR_ILL	HISTORY	PRIOR_VAX	SPLTTYPE	FORM_VERS	TODAYS_DATE	BIRTH_DEFECT	OFC_VISIT	ER_ED_VISIT	ALLERGIES	Link 1	Link 2
0946298	01/15/2021	MD	17.0	17		F		17 y/o receiving vaccine for 18 and older.									Y	01/13/2021	01/13/2021	0		PUB							2	01/15/2021					2021VAERSSYMPTOMS	2021VAERSVAX
0946311	01/15/2021	MD	17.0	17		F		Received vaccine at 17 y/o. No reactions.									Y	01/13/2021	01/13/2021	0		PUB							2	01/15/2021					2021VAERSSYMPTOMS	2021VAERSVAX
0961125	01/21/2021	MD	17.0	17		M		Administrative error- The vaccine was given to a 17 year old male, which is outside EUA. No adverse events related to the vaccine.									Y	01/12/2021	01/12/2021	0	none	PUB		unk		immune disorder			2	01/21/2021				unk	2021VAERSSYMPTOMS	2021VAERSVAX
0967977	01/23/2021	MD	17.0	17		F		patient was administered vaccine 08/23/20 , patient noticed soreness to the injection site, 1 week later patient noticed a hard bump on the site, red, discomfort from shot. symptoms have not gone away									U	08/23/2020	08/30/2020	7		PHM							2	01/23/2021					2021VAERSSYMPTOMS	2021VAERSVAX
0986289	01/29/2021	MD	17.0	17		F		17 year old.									U	01/07/2021	01/07/2021	0	None	PUB		no	None	N/A			2	01/29/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
0986353	01/29/2021	MD	17.0	17		F		17 Year old									U	01/08/2021	01/08/2021	0	No	PUB		Unknown	None	None			2	01/29/2021				Unknown	2021VAERSSYMPTOMS	2021VAERSVAX
0986422	01/29/2021	MD	17.0	17		F		17 Year Old									U	01/08/2021	01/08/2021	0	N/A	PUB		None	None	Non e			2	01/29/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
0986454	01/29/2021	MD	17.0	17		F		17 Year old									U	01/08/2021	01/08/2021	0	N/A	PUB		N/A	N/A	N/A			2	01/29/2021				NKDAQ	2021VAERSSYMPTOMS	2021VAERSVAX
1017310	02/09/2021	MD	17.0	17		M		Vaccination error, person under the age of 18. No adverse events reported by mother or patient.									Y	01/06/2021	01/06/2021	0	none reported	PUB		unknown	none reported	none reported		123892	2	02/09/2021				none reported	2021VAERSSYMPTOMS	2021VAERSVAX
1030488	02/15/2021	MD	17.0	17		M		Patient is under 18 years old and currently is an employee at a supermarket, we did not realized his age until after we gave him the shot. Pt experience no abnormal adverse effects.									Y	02/11/2021	02/11/2021	0	n/a	PHM		n/a	n/a	n/a			2	02/15/2021				NKA	2021VAERSSYMPTOMS	2021VAERSVAX
1052167	02/24/2021	MD	17.0	17		M		Patient presented at vaccination table and identity was confirmed with two unique identifiers (including DOB). Present writer reviewed patient's responses to screening form completed in PrepMod and also screened patient to confirm he was feeling well, had									Y	01/28/2021	01/28/2021	0		PUB							2	02/24/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1060113	02/27/2021	MD	17.0	17		M		Patient 17 years old and 5 months and given the covid vaccine									U	02/26/2021	02/26/2021	0	N/a	PHM							2	02/27/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1060134	02/27/2021	MD	17.0	17		M		Patient is 17 years and 8months but was given Moderna covid 19 vaccine									U	02/26/2021	02/26/2021	0		PHM							2	02/27/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1063509	03/01/2021	MD	17.0	17		M		Patient is 17 years old but received vaccination that is approved for 18 years and older under EUA									U	02/26/2021	02/26/2021	0		PHM							2	03/01/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1079017	03/07/2021	MD	17.0	17		M		Patient is 5 days younger than the recommended age of 18 yrs for Moderna.									U	03/05/2021	03/05/2021	0	n/a	OTH		n/a	n/a	n/a			2	03/07/2021				n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1092104	03/11/2021	MD	17.0	17		F		Pharmacist administered the vaccine to age-contraindicated patient. Patient self-reported to be 18 years of age on vaccine consent form. Patient's actual age is 17 years old.									U	03/03/2021	03/03/2021	0		UNK		N/A	N/A	N/A			2	03/11/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1092109	03/11/2021	MD	17.0	17		M		Age-Vaccine contraindication, 17 year old patient was inoculated with Moderna brand of the COVID 19 vaccine which is approved for patients 18 years old and older.									U	03/10/2021	03/10/2021	0		PHM				Mental disability			2	03/11/2021				Nuts	2021VAERSSYMPTOMS	2021VAERSVAX
1092654	03/11/2021	MD	17.0	17		M		Vaccine age contraindication; 17 year old patient was injected Moderna brand COVID 19 vaccine which is approved for patients 18 years and older. Vaccination occurred on 03/10/21. Patient's mother was contacted on 03/11/21 for follow up. Patient's mother									U	03/10/2021	03/10/2021	0		PHM				Mental disease			2	03/11/2021				Nuts	2021VAERSSYMPTOMS	2021VAERSVAX
1110515	03/18/2021	MD	17.0	17		F		An under age client came to the vaccination clinic site. Client was vaccinated, but no symptoms or side effects were reported post vaccination. Client was able to go through registration with a note indicating client birthdate was incorrect with the vaccin									U	03/18/2021	03/18/2021	0		PUB							2	03/18/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1118024	03/20/2021	MD	17.0	17		F		itching one arm in one spot with brief throat itching. Pt felt much better with parents driving her. Called family on phone daughter doing better went to store									Y	03/20/2021	03/20/2021	0	N/a	OTH		Keppra	Seizure				2	03/20/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1120268	03/21/2021	MD	17.0	17		F		The patient was vaccinated inadvertently by staff who did not realize that the Moderna vaccine was not approved for those under 18. She did not have any adverse effects at the time of vaccination or afterward. I spoke with her on the phone about an hour a									Y	03/18/2021	03/18/2021	0	n/a	PUB		n/a	n/a	n/a			2	03/21/2021				none known	2021VAERSSYMPTOMS	2021VAERSVAX
1120293	03/21/2021	MD	17.0	17		M		The patient was vaccinated inadvertently by staff who did not realize that the Moderna vaccine was not approved for those under 18. He did not have any adverse effects at the time of vaccination or afterward. I spoke with him on the phone about an hour af									Y	03/18/2021	03/18/2021	0	n/a	PUB		n/a	n/a	n/a			2	03/21/2021				n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1123902	03/22/2021	MD	17.0	17		M		No adverse events reported - patient was out of age range of Emergency Use Authorization.									Y	03/15/2021	03/15/2021	0		PUB							2	03/22/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1129898	03/24/2021	MD	17.0	17		F		Patient presented at vaccination table after having documents and appointment reviewed by non-clinical staff, and identity was confirmed by nurse vaccinator using two unique identifiers (including DOB). Nurse vaccinator reviewed patient's responses to scre									Y	03/16/2021	03/16/2021	0	none	PUB		unknown	none	none			2	03/24/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1137541	03/26/2021	MD	17.0	17		F		Underage to receive Moderna vaccine.									U	03/25/2021	03/25/2021	0	None reported	PUB		None noted	None noted	None noted			2	03/26/2021				None noted	2021VAERSSYMPTOMS	2021VAERSVAX
1137562	03/26/2021	MD	17.0	17		M		Underage to receive Moderna vaccine.									U	03/25/2021	03/25/2021	0	None reported	PUB		None reported	None reported	None reported			2	03/26/2021				None reported	2021VAERSSYMPTOMS	2021VAERSVAX
1137987	03/26/2021	MD	17.0	17		M		Pt is under 18 years old									Y	03/26/2021	03/26/2021	0	n/a	PHM		n/a	n/a	n/a			2	03/26/2021				n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1155589	04/01/2021	MD	17.0	17		F		Received the Moderna vaccine and is 17 years old, no adverse reactions.									Y	03/03/2021	03/03/2021	0		PUB		Unknown	Unknown	Unknown			2	04/01/2021				Unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1164750	04/03/2021	MD	17.0	17		F		No adverse event reported but patient received both doses of Moderna COVID-19 vaccine at the age of 17 rather than 18 as FDA approved.									Y	04/03/2021	04/03/2021	0	N/A	PHM		Microgestin Fe 1.5/30mcg	N/A	N/A			2	04/03/2021				No known drug allergy	2021VAERSSYMPTOMS	2021VAERSVAX
1179685	04/08/2021	MD	17.0	17		F		Pt .c/o feeling light headed and was verbal, A$Ox 4. She was taken in a wheelchair to a cubicle where she was asked to lay down in a cot. 2 small packets of crackers , 3 pkts of apple juice and water were offered. Total fluid intake - 500 mls. Pt. verbali									Y	04/07/2021	04/07/2021	0	none	PUB		none	Type 1 diabetes	Type 1 diabetes			2	04/08/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1182591	04/08/2021	MD	17.0	17		F		Patient was immunized at 17 years old and 8 months.										04/08/2021	04/08/2021	0		PUB							2	04/08/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1191493	04/10/2021	MD	17.0	17		M		The individual starts to show signs of anaphylaxis reaction some minutes after vaccination by the nurse. Said"I am not feeling good." Upon assessment, the individual is leaning his head backwards, unable to read how many fingers I held up; complained "can'									Y	04/09/2021	04/09/2021	0		PUB		none	none	none			2	04/10/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1198124	04/12/2021	MD	17.0	17		F		PT WAS ONLY 17 AND RECEIVED VACCINE - MODERNA INDICATED FOR 18+										04/11/2021	04/11/2021	0		PUB							2	04/12/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1205380	04/13/2021	MD	17.0	17		F		patient fainted after receiving vaccine - her dad was with her here in the pharmacy and stated that this was typical of her when getting blood drawn/needles									Y	04/13/2021	04/13/2021	0		PHM		none that we know of	none that we know of	none that we know of			2	04/13/2021				nkda	2021VAERSSYMPTOMS	2021VAERSVAX
1207416	04/14/2021	MD	17.0	17		F		moderna vaccine was given to pt no major side effect just sore arm									Y	04/13/2021	04/14/2021	1		PHM							2	04/14/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1208036	04/14/2021	MD	17.0	17		F		Patient developed muscle pain and swelling in anterior shoulder area anterior to neck between clavicle and anterior neck , No mass but there was generalized swelling no redness									N	04/06/2021	04/12/2021	6	none	PHM			No	Exercise triggered asthma			2	04/14/2021		Y		Neosporin and neomycin sulfate polymixin B sulfate	2021VAERSSYMPTOMS	2021VAERSVAX
1208523	04/14/2021	MD	17.0	17		F		The patient's current age is 17 and the Moderna COVID19 vaccination is currently only given to patients age 18 and over. There is no adverse event other than the age being incorrect - this is an administrative error.									Y	04/13/2021	04/13/2021	0	None	PHM		N/A	N/A	N/A			2	04/14/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1209489	04/14/2021	MD	17.0	17		M		Realized after the patient was vaccinated that he was under 18 years old. Pt had no side effects for the 15 minutes of observation and has not reported any since the vaccination.									U	04/03/2021	04/03/2021	0	N/A	PHM		Unknown	none reported	none reported			2	04/14/2021				None reported	2021VAERSSYMPTOMS	2021VAERSVAX
1211976	04/15/2021	MD	17.0	17		F		congestion and cough									N	04/13/2021	04/15/2021	2		UNK		lexapro, junel fe, burosumab		x linked hypophosphatemia			2	04/15/2021				apples	2021VAERSSYMPTOMS	2021VAERSVAX
1214708	04/15/2021	MD	17.0	17		F		pt looked pale 10 minutes after vaccine went out to check on him he was getting faint and lips looked purple, was NOT having breathing problems and BP was normal at 104/54, called 911 patient was very clammy and sweaty, stayed with patient until paramedics									U	04/15/2021	04/15/2021	0	unknown at this time	PHM		none	none	none			2	04/15/2021			Y	none	2021VAERSSYMPTOMS	2021VAERSVAX
1218959	04/16/2021	MD	17.0	17		M		Patient received Vaccine and not age appropriate										03/31/2021	03/31/2021	0		OTH							2	04/16/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1219777	04/16/2021	MD	17.0	17		M		Moderna vaccine was given to a 17 yo male. This vaccine is not currently authorized to be given to patients under 18 yoa.									Y	04/14/2021	04/14/2021	0		OTH							2	04/16/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1219875	04/16/2021	MD	17.0	17		F		none. unauthorized age group. Patient < 18 years old.									U	04/16/2021	04/16/2021	0	none	PVT		Per patient report, she had been in the ER the night prior because she had been smoking marijuana that was laced with another unknown substance. However, this was not mentioned until after vaccine had been administrated.					2	04/16/2021				penicillin	2021VAERSSYMPTOMS	2021VAERSVAX
1221035	04/16/2021	MD	17.0	17		F		Lip swelling nd tingling of lips. No other symptoms.									Y	04/09/2021	04/10/2021	1	None	OTH		Vitamin D Vitamin C	None	Asthma Klippel-Feil Syndrome			2	04/16/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1226319	04/18/2021	MD	17.0	17		M		Injection given to person under age of 18									U	04/11/2021	04/11/2021	0		PHM							2	04/18/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1226329	04/18/2021	MD	17.0	17		F		Vaccine given to someone under age 18									U	04/11/2021	04/11/2021	0		PHM							2	04/18/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1232514	04/20/2021	MD	17.0	17		M		After the patient received the vaccine it was found that the patient was 17. There were no side effects reported during the 15 minute observation after the vaccine.									U	04/20/2021	04/20/2021	0		OTH							2	04/20/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1232800	04/20/2021	MD	17.0	17		F		after shot administered pt reported worst dizziness they have ever experienced, ringing in ears, and blurred vision, had pt lay in supine position with feet elevated, all sx resolved within 15-20 minutes, advised pt to follow up w/ PCP									Y	04/20/2021	04/20/2021	0		PHM							2	04/20/2021				penicillin	2021VAERSSYMPTOMS	2021VAERSVAX
1244046	04/22/2021	MD	17.0	17		F		A few minutes after receiving the vaccine, the patient complained of feeling hot, flushed, and faint. She then wanted to lie down on the floor. I called an ambulance, as she refused to let me take her blood pressure. When the EMTs arrived, she was sitti										04/22/2021	04/22/2021	0		PHM							2	04/22/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1244848	04/22/2021	MD	17.0	17		F		This was 2nd Pfizer Shot/No side effects with 1st Bumps and large rashes all over the body/itching Have it sought dr at this time...OTC meds									N	04/20/2021	04/21/2021	1	N/A	OTH		Singular Lexapro generic	N/A	Mild Asthma			2	04/22/2021				Penicillin	2021VAERSSYMPTOMS	2021VAERSVAX
1246317	04/23/2021	MD	17.0	17		M		No adverse raection										04/20/2021	04/20/2021	0		OTH		n/a	n/a	n/a			2	04/23/2021				n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1252414	04/24/2021	MD	17.0	17		M		About 3 minutes after administration of vaccine reported ?seeing black? , loss of vision, began to perspire and looked pale. Lasted about 2 minutes.									Y	04/23/2021	04/23/2021	0	Blood pressure and pulse taken by RN on site - normal	PUB		None	None	None			2	04/24/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1256128	04/25/2021	MD	17.0	17		F		No symptoms									U	04/21/2021	04/21/2021	0	n/a	OTH		not available	n/a	n/a			2	04/25/2021				n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1266373	04/28/2021	MD	17.0	17		F		Pt. C/O feeling light-headed and nauseated while sitting at the observation hall. She vomited some undigested food particles after sipping some fruit juice offered by her mother. Writer to her in a wheelchair to the cubicle in the observation hall for fur									Y	04/28/2021	04/28/2021	0	none	PUB		none	Type 1 diabetes	Type 1 diabetes			2	04/28/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1267732	04/28/2021	MD	17.0	17		M		patient had vasovagal episode immediatly after receiving the vaccination, there was vomiting associated with the episode. Patient vitals remained stable, he was observed for 30 minutes, given juice, water and crackers and able to ambulate without difficult									Y	04/28/2021	04/28/2021	0	none	OTH		none	none	none	vasovagal		2	04/28/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1271685	04/29/2021	MD	17.0	17		F		Patient was Vaccinated with Moderna at age of 17 years instead of 18 years. No adverse effects or symptoms									Y	04/21/2021	04/01/2021		None	PUB		none	None	None			2	04/29/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1274944	04/30/2021	MD	17.0	17		M		Patient age does not meet protocol, discovered after vaccination									Y	04/30/2021	04/30/2021	0		PHM							2	04/30/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1275021	04/30/2021	MD	17.0	17		F		Patient presented to the vaccine to receive COVID 19 vaccine. The patient was given the Moderna brand of the COVID 19 vaccine which is only approved for patients 18 years of age and older. No adverse event occurred during the 15 minutes post vaccination									Y	04/30/2021	04/30/2021	0		PHM							2	04/30/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1278162	05/01/2021	MD	17.0	17		M		Hypersensitivity to sounds, movement. ?I feel really weird. Everything around me feels overwhelming. I hear a bird?s wings flapping the same as people talking next to me, and notice any movement around me ? Started about 4 hours post vaccination and las									Y	04/29/2021	04/29/2021	0		OTH		None	None	None	Allergic reaction to influenza vaccine followed by neurological symptoms at 11 months.		2	05/01/2021				Allergic to tree nuts, amoxicillin, had previous reaction to influenza vaccine	2021VAERSSYMPTOMS	2021VAERSVAX
1281255	05/03/2021	MD	17.0	17		M		Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed/Sweating-Mild, Systemic: Weakness-Mild, Additional Details: FOLLOWED UP WITH PATIENT AT 6:30P ON 05/02/2021. DAD SAID PATIENT IS DOING OK NOW. HE EATS AND TALK NORMALLY.									Y	05/02/2021	05/02/2021	0		PHM							2	05/03/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1281594	05/03/2021	MD	17.0	17		M		Visually observed patient looked faint for approximately 5 seconds Patient was reclined on cot, given juice & crackers, BP checked 1st 110/70 BP was weak Patient was observed for 30 minutes, patient verbally reported he was feel much better Left the facil									Y	05/03/2021	05/03/2021	0		PUB		not know	None	None			2	05/03/2021				NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1281862	05/03/2021	MD	17.0	17		M		Registrant was 17y9m received first dose of Moderna Vaccine inadvertently. Registrants parent and physician have been notified by nursing supervisor VAERS report submitted									U	04/28/2021	04/28/2021	0	unknown	PUB		unknown	no - per form	no - per form			2	05/03/2021				no - per form	2021VAERSSYMPTOMS	2021VAERSVAX
1286648	05/04/2021	MD	17.0	17		F		Full body aches, grueling and throbbing headache									N	05/03/2021	05/04/2021	1		PHM		N/A	Non-COVID virus (was tested and came back negative), only experienced side effects after second dose	N/A	Meningitis B		2	05/04/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1289926	05/05/2021	MD	17.0	17		M		The patient is 17 years old, underage to receive this vaccine product. When realized, the patient had left. Calls were made to the patient on 1/28/2021 with a voicemail to return this call. Parents were called on 1/28 with a voicemail left for. COnversatio									Y	01/28/2021	01/28/2021	0	NA	OTH		None reported	None reported	None reported			2	05/05/2021				None reported	2021VAERSSYMPTOMS	2021VAERSVAX
1289966	05/05/2021	MD	17.0	17		M		Severe nose bleeding happened after both doses vaccination and randomly continued									N	05/01/2021	05/02/2021	1		PHM		Evekeo, 10 mg Vitamin B complex, Vitamin D3	First dose of Pfizer was gotten on Apr 9, 2021, severe nose bleeding happened on second day, then happened on different days randomly. The nose bleeding occurred again after receiving second dose on May 1		First dose		2	05/05/2021		Y			2021VAERSSYMPTOMS	2021VAERSVAX
1291808	05/06/2021	MD	17.0	17		M		Patient is having fever, chills, nausea, and feeling of coldness now 5 days after receiving the second dose of Pfizer vaccine. He has been unable to eat much food and unable to sleep much due to feeling cold and having a fever.									U	05/01/2021	05/02/2021	1		OTH		None	None	None			2	05/06/2021			Y	Amoxicillin, bananas, kiwi	2021VAERSSYMPTOMS	2021VAERSVAX
1293329	05/06/2021	MD	17.0	17		F		Patient developed nausea, dizziness, lightheadedness, tingling and contraction of hands within 5 minutes of receiving vaccine. Resolved with po fluids only.									Y	05/06/2021	05/06/2021	0		OTH		Zoloft	None	None			2	05/06/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1297037	05/07/2021	MD	17.0	17		M		MODERNA VACCINE ADMINISTERED TO PATIENT UNDER THE AGE OF 18. NO ADVERSE REACTION									Y	05/05/2021	05/05/2021	0	NONE	PHM		NONE	NONE	NONE			2	05/07/2021				TREENUTS	2021VAERSSYMPTOMS	2021VAERSVAX
1302809	05/10/2021	MD	17.0	17		M		This is not an adverse reaction reporting but reporting of a deviation from approved manufacture's age requirement for Moderna COVID-19 Vaccine with parental consent. 17 yo male patient presented for Moderna Covid #2 on May 7, 2021. Screening RN notified										04/08/2021	05/07/2021	29	None	MIL		Unknown	None	None			2	05/10/2021				NKA	2021VAERSSYMPTOMS	2021VAERSVAX
1307513	05/11/2021	MD	17.0	17		F		Moderna was given to under 18										05/11/2021	05/11/2021	0		PHM							2	05/11/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1307639	05/11/2021	MD	17.0	17		M		Complained of nausea, next day, vomited. C/o burning and throbbing in opposite of vaccine injection site. 4pm low grade fever. C/o he can't breathe. C/o burning of chest. States better on Sunday after taking benadryl and nyquil mom stated. Administered by									Y	05/07/2021	05/08/2021	1	nons	SCH		None	no. Mom states he does seem to have some anxiety.	Possible Anxiety			2	05/11/2021				No	2021VAERSSYMPTOMS	2021VAERSVAX
1307885	05/11/2021	MD	17.0	17		F		Patient was given the Moderna vaccine. Patient is under the age of 18. Patients is currently 17 years old.									Y	05/11/2021	05/11/2021	0	No	PVT		No	No	No			2	05/11/2021				No	2021VAERSSYMPTOMS	2021VAERSVAX
1311749	05/12/2021	MD	17.0	17		M		patient is 17 years old. should not have received Janssen vaccine									Y	05/12/2021	05/12/2021	0		PHM		NA	NA	NA			2	05/12/2021				NA	2021VAERSSYMPTOMS	2021VAERSVAX
1313772	05/13/2021	MD	17.0	17		M		Cellulitis left foot Treatment: Oral Cephalexin 500 mg twice a day for 7 days									Y	04/13/2021	04/17/2021	4	Nil	PVT		Nil	Nil	Nil			2	05/13/2021				Nil	2021VAERSSYMPTOMS	2021VAERSVAX
1315437	05/13/2021	MD	17.0	17		M		age is 17, vaccine given is recommended for 18 and older									Y	04/14/2021	05/13/2021	29	none	PHM		none	none	none			2	05/13/2021		Y		none	2021VAERSSYMPTOMS	2021VAERSVAX
1315449	05/13/2021	MD	17.0	17		M		patient is 17, receiving vaccine for 18 and older									Y	04/02/2021	05/13/2021	41	none	PHM		none	none	none			2	05/13/2021		Y		none	2021VAERSSYMPTOMS	2021VAERSVAX
1321924	05/16/2021	MD	17.0	17		F		Error: Incorrect Reconstitution									U	05/16/2021	05/16/2021	0		PHM							2	05/16/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1323564	05/17/2021	MD	17.0	17		M		Painful mouth sores erupted on back of throat 2 days after vaccine. Extreme sore throat. Sores and fatigue lasted for 10 days after shot.									N	05/08/2021	05/09/2021	1	Covid-19 negative, strep negative and mono negative on 5/16/21	PUB		None	None	None			2	05/17/2021		Y		tree nut allergy	2021VAERSSYMPTOMS	2021VAERSVAX
1327432	05/18/2021	MD	17.0	17		M		17 y.o. male who presents with chest pain, elevated troponins and diffuse ST elevations concerning for pericarditis vs myocarditis admitted for cardiac monitoring and evaluation. Pt states he has had 1 day of sudden onset L shoulder pain and chest pain. En					Y	3			Y	05/12/2021	05/14/2021	2	Hematocrit 43.4 (5/15/2021) Hemoglobin 15.2 (5/15/2021) Platelets 148 (5/15/2021) RBC 4.76 (5/15/2021) WBC 12.83* (5/15/2021) Albumin 4.3 (5/15/2021) Alk Phos 90 (5/15/2021) ALT 56* (5/15/2021) AST 53* (5/15/2021) Bilirubin Total 0.6 (5/15/2021) BUN 13 (5	PVT		None	None	None			2	05/18/2021			Y	None	2021VAERSSYMPTOMS	2021VAERSVAX
1331743	05/19/2021	MD	17.0	17		M		Syncope shortly after the shot									Y	05/19/2021	05/19/2021	0	none	PHM		unknown	none	none			2	05/19/2021				none	2021VAERSSYMPTOMS	2021VAERSVAX
1334472	05/20/2021	MD	17.0	17		F		Shot given 11:58am. Within 2 minutes symptoms began with feeling symptoms: nauseous, hot forehead. I asked CVS for the nurse to help. By 12:01 patient was feeling extreme pain in her stomach, was sweating profusely, felt tingling sensation from head down t									Y	05/19/2021	05/19/2021	0	No medical or laboratory tests were performed at Hospital on 5/19/2021	PHM		Escitalopram 5mg/day	None	None, though patient is gluten and lactose sensitive.			2	05/20/2021		Y	Y	Severely allergic to pine nuts. Needs epi pen	2021VAERSSYMPTOMS	2021VAERSVAX
1334626	05/20/2021	MD	17.0	17		F		Patient was given dose at a vaccination site through County Health Department. Today in clinic she reported an allergic reaction to Pfizer vaccine. Approximately 30 minutes following vaccination had hives. Following morning had swollen lips and itchy throa									Y	04/30/2021	04/30/2021	0		PVT							2	05/20/2021				Amoxicillin - hives	2021VAERSSYMPTOMS	2021VAERSVAX
1340644	05/22/2021	MD	17.0	17		M		5/13 began as flu like , 5/14 6:00 pm couldn?t get full breath, went to Patient 1st, chest X-ray nothing , 5/15 4:00 am shoulder pain, couldn?t get full breath, Went to Hospital ER, Ekg progressively abnormal, Troponin and C reactive values increasing, tr					Y	4			N	05/12/2021	05/13/2021	1	Too many to list in my allotted 5 minutes! Troponin high, c reactive high	PHM		None	None	None			2	05/22/2021		Y	Y	Promethezine	2021VAERSSYMPTOMS	2021VAERSVAX
1340852	05/22/2021	MD	17.0	17		F		DIZZINESS									Y	05/22/2021	05/22/2021	0		OTH		none	none	colitis			2	05/22/2021				Bee/wasp stings	2021VAERSSYMPTOMS	2021VAERSVAX
1340883	05/22/2021	MD	17.0	17		F		Patient feeling her throat is swollen with a lump vs sat 98% HR 81 bp 131/70 patient felt better immediately after IM Benadryl was OBS for 45 mins and requesting discharge home was with mother									Y	05/22/2021	05/22/2021	0		OTH		NONE	NONE	COLITIS			2	05/22/2021				BEE WASP STING	2021VAERSSYMPTOMS	2021VAERSVAX
1343005	05/24/2021	MD	17.0	17		F		Systemic: Fainting / Unresponsive-Mild, Systemic: Headache-Mild									Y	05/23/2021	05/23/2021	0		PHM							2	05/24/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1354254	05/27/2021	MD	17.0	17		F		Moderate Swelling of lymph node behind ear and smaller swelling at base of cranium									U	05/20/2021	05/23/2021	3		PHM							2	05/27/2021				Amoxicillin	2021VAERSSYMPTOMS	2021VAERSVAX
1385169	05/30/2021	MD	17.0	17		M		Chest pain requiring hospital observation					Y				U	05/26/2021	05/29/2021	3	5/29/21 Troponin 0.4, 4.10 EKG with St elevation of inferior leads	SCH		none	none	none			2	05/29/2021			Y	cefdinir	2021VAERSSYMPTOMS	2021VAERSVAX
1362391	05/31/2021	MD	17.0	17		M		Chest pain w/elevated troponins and small ST elevations in infero/lateral leads concerning for myocarditis					Y	1			U	05/25/2021	05/28/2021	3	Troponin 13.5 5/30/21 4pm; downtrended to 7.74 5/31/21 6am	UNK		Methylphenidate		Anxiety, ADHD			2	05/31/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1362397	05/31/2021	MD	17.0	17		F		Site: Pain at Injection Site-Mild, Systemic: mentrual changes-Mild, Additional Details: headaches, no appetite, stomach ache, light sensitivity, fatigue, mentrual cycle distrupted. Patient states she got her period 2 weeks early. She takes an oral contrace									N	05/28/2021	05/30/2021	2		PHM							2	05/31/2021		Y			2021VAERSSYMPTOMS	2021VAERSVAX
1364659	06/01/2021	MD	17.0	17		M		chest pain Saturday morning actually resolved, but had troponins 3800 then 4160, trending down. Telemetery and check labs going down. Our ECHO and EKG were fine, as was proBNP, d-dimers.					Y				Y	05/26/2021	05/29/2021	3		PVT							2	06/01/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1382146	06/08/2021	MD	17.0	17		M		seizure within 3 min of receiving vaccine, sent to hospital by ambulance.			Y						U	06/05/2021	06/05/2021	0	MRI, etc. Non-epileptic seizure	SCH		Vyvanse	none	none			2	06/08/2021			Y	none	2021VAERSSYMPTOMS	2021VAERSVAX
1382480	06/08/2021	MD	17.0	17		M		No adverse reaction. Pt 17 yo, was given dose #1 off- label initially with parental consent and consent of the patient as he was almost 18 y/o. First dose of moderna given on April 08 2021. He also will be working in a public facing position as a lifeguar										05/27/2021			None	MIL							2	06/08/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1393244	06/11/2021	MD	17.0	17		F		Within seconds of receiving the 2nd PFizer covid vaccine, the patient slumped over sideways in her chair, losing consciousness. Next, her arms went straight and locked, both her hands locked in a curled position. I looked up at her face and her eyes had									U	06/11/2021	06/11/2021	0		PHM							2	06/11/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1395422	06/14/2021	MD	17.0	17		M		Chest pain and elevated troponins concerning for myocarditis					Y	3			N	06/07/2021	06/10/2021	3	Results for as of 6/14/2021 08:28 6/11/2021 14:24 Troponin I: 13.00 (AA) 6/11/2021 20:12 Troponin I: 9.88 (AA) 6/12/2021 02:43 Troponin I: 9.61 (AA) 6/12/2021 04:26 Troponin I: 12.40 (AA) 6/13/2021 05:00 Troponin I: 9.10 (AA) 6/14/2021 04:38 Troponin I: 3.	PVT		None	None	None			2	06/14/2021			Y	No known	2021VAERSSYMPTOMS	2021VAERSVAX
1395854	06/14/2021	MD	17.0	17		M		Patient was 17 and received JnJ. Should have received Pfizer									Y	06/12/2021	06/12/2021	0	N/A	PHM		N/A	N/A	N/A			2	06/14/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1400279	06/15/2021	MD	17.0	17		F		The 17-year-old patient was accidentally given the Moderna vaccine a month prior by , but was advised to get her second dose anyway to finish the series. The nurse who gave her this injection (second for the patient) did not realize that the patient was u									Y	05/20/2021	05/20/2021	0		PUB					As mentioned above, first Moderna shot was given while underage		2	06/15/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1400313	06/15/2021	MD	17.0	17		M		Positive diagnosis COVID-19 on June 15, 2021									N	04/13/2021	06/05/2021	53	Rapid test COVID-19 positive	PVT		None	None	None			2	06/15/2021		Y		None	2021VAERSSYMPTOMS	2021VAERSVAX
1408203	06/17/2021	MD	17.0	17		M		There was no adverse event however the patient was given the janssen vaccine while they were only 17 years old at the time.									U	06/17/2021	06/17/2021	0	none	PHM		unknown	unknown	unknown			2	06/17/2021				unknown	2021VAERSSYMPTOMS	2021VAERSVAX
1417957	06/22/2021	MD	17.0	17		M		Underaged patient (17yrs, 9 months) received Janssen COVID 19 vaccine which is indicated for 18+									U	06/22/2021	06/22/2021	0		PHM							2	06/22/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1423461	06/24/2021	MD	17.0	17		M		Patient was accidentally given his first dose of the Moderna COVID vaccine 5 days shy of his eighteenth birthday. Other than the underage administration error, there were no adverse effects to report. The patient received his second dose in the series (Lot									Y	01/13/2021	01/13/2021	0		PUB							2	06/23/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1423475	06/24/2021	MD	17.0	17		M		Patient was accidentally given the Moderna vaccine while 17 years old on 1/13/21 and came back to finish the vaccination series on 2/10/21. There were no adverse effects to report for either vaccination other than the underage administration error.									Y	02/10/2021	02/10/2021	0		PUB							2	06/24/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1423479	06/24/2021	MD	17.0	17		F		Patient was accidentally given vaccine while underage (17 years old) on 3/23/21 and came back to complete vaccination series on 4/20/21. Besides the administration error there were no adverse effects to report.									Y	04/20/2021	04/20/2021	0		PUB							2	06/23/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1431066	06/28/2021	MD	17.0	17		M		Patient with 1 day of chest pain, leading to ER visit that same day and admission to hospital with concern for myocarditis. Currently admitted to hospital awaiting further workup.					Y	2			N	06/24/2021	06/27/2021	3	6/27 - Troponin I - 0.6 (normal range 0-0.1) 6/28 - Troponin I - 13.3 (normal range	UNK		None	None	None			2	06/28/2021				No known allergies	2021VAERSSYMPTOMS	2021VAERSVAX
1433492	06/29/2021	MD	17.0	17		F		Pt. under age at time of vaccine										04/22/2021	04/22/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1433504	06/29/2021	MD	17.0	17		F		Pt. under age at time of vaccine										04/23/2021	04/23/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1433518	06/29/2021	MD	17.0	17		M		Pt. under age at time of vaccine										04/28/2021	04/28/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1433522	06/29/2021	MD	17.0	17		M		Pt. under age at time of visit										05/26/2021	05/26/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1433574	06/29/2021	MD	17.0	17		F		Pt. under age at time of vaccination										05/17/2021	05/17/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1433588	06/29/2021	MD	17.0	17		M		Pt. under age at time of vaccine										05/14/2021	05/14/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1433603	06/29/2021	MD	17.0	17		F		Pt. under age at time of vaccination										04/17/2021	04/17/2021	0		PVT							2	06/29/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1456787	07/08/2021	MD	17.0	17		M		Error: Patient Too Young for Vaccine Administered-									Y	05/15/2021	05/15/2021	0		PHM							2	07/08/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1460158	07/09/2021	MD	17.0	17		M		COVID vaccine-associated myocarditis. 3 days after his second Pfizer COVID vaccine, pt presented for chest pain and pressure. Troponin was initially elevated to 4.2, EKG showed ST elevations in lateral leads. Over the course of his stay, troponin dropped,					Y	3			Y	06/30/2021	07/03/2021	3	Troponins peaked at 14 . Negative HSV, EBV, Coxsackie, CMV, adenovirus. TSH, free T4, triglycerides wnl. Pro-BNP elevated to 224. Cardiac MRI: IMPRESSION: 1. Subepicardial delayed gadolinium enhancement of the left ventricular inferolateral wall wh	UNK		None	None	None			2	07/09/2021			Y	None	2021VAERSSYMPTOMS	2021VAERSVAX
1461959	07/10/2021	MD	17.0	17		M		Error: Patient Too Young for Vaccine Administered-									U	06/09/2021	06/09/2021	0		PHM							2	07/10/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1466894	07/13/2021	MD	17.0	17		M		Error: Patient Too Young for Vaccine Administered-									Y	04/07/2021	04/07/2021	0		PHM							2	07/13/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1478652	07/16/2021	MD	17.0	17		F		Vaccine was inadvertently given to 17 year old									Y	07/16/2021	07/16/2021	0		PHM							2	07/16/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1490258	07/21/2021	MD	17.0	17		F		Error: Patient Too Young for Vaccine Administered-									U	07/13/2021	07/13/2021	0		OTH							2	07/21/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1490701	07/21/2021	MD	17.0	17		F		Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will nee									U	07/06/2021	07/06/2021	0		PHM							2	07/21/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1509444	07/28/2021	MD	17.0	17		F		Error: Patient Too Young for Vaccine Administered-									U	07/13/2021	07/13/2021	0		OTH							2	07/28/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1512397	07/29/2021	MD	17.0	17		F		Mother states that patient got vaccine on 07/28/2021, and that same night patient was having severe body pain. And next day, patient had pains in right leg.									N	07/28/2021	07/28/2021	0		PVT		NONE	NONE	NONE			2	07/29/2021				NONE	2021VAERSSYMPTOMS	2021VAERSVAX
1512428	07/29/2021	MD	17.0	17		F		Symptoms: patient experiencing left arm pain with full range of motion, but muscle soreness and muscle pain status post 5 days after the Bexero was administered. Patient c/o of immediate area surrounding the vaccine administration was "feeling slightly fir									Y	07/22/2021	07/22/2021	0	No additional medical and laboratory results were advised. Followed up with the patient and advised the patient to take ibuprofen or aleve for pain relief and to decrease inflammation with cool or warm compress.	PVT		ciclopirox (Penlac) 8% solution to nails; ketoconazole (Nizoral) 2% topical cream for tinea pedis; no oral medications	No illness; healthy 17 yo patient	None			2	07/29/2021		Y		NKDA	2021VAERSSYMPTOMS	2021VAERSVAX
1515428	07/30/2021	MD	17.0	17		M		He didn't have irritation or redness at the injection site. The next morning at 7:45 am feeling really tired had headache he had a fever of 100. He went to bed his fever worsened that evening (on 7/19 100.4,5:25 PM ET,100.8, 8:30 PM ET ). At that point he					Y	3			N	07/18/2021	07/19/2021	1	Blood work(3 times a day due to platelets dropping), EKG(results normal),Covid Test (results negative)	PHM		No	No	No		vsafe	2	07/30/2021		Y	Y	No	2021VAERSSYMPTOMS	2021VAERSVAX
1529758	08/05/2021	MD	17.0	17		F		While screening the patient for the 2nd dose, she told me that she had trouble breathing around midnight the night that the 1st dose was administered. She said she was having anxiety and she thinks it might have been from that. Her father offered to take h									Y	06/24/2021	06/25/2021	1		PHM							2	08/05/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1529760	08/05/2021	MD	17.0	17		F		Patient presented to clinic and registered as 18 y/o for Janssen vaccine. Patient presented school ID, stated she did not have her drivers license. I scanned ID in chart and verified all demographic information including DOB. Patient stated all information										08/05/2021	08/05/2021	0	N/A	OTH			no				2	08/05/2021				eggs	2021VAERSSYMPTOMS	2021VAERSVAX
1530449	08/06/2021	MD	17.0	17		M		Administrated / after a below freezing temperature excursion; This case was reported by a physician via call center representative and described the occurrence of incorrect product storage in a 17-year-old male patient who received HAV (Havrix) (batch numb									U	07/21/2021				UNK						USGLAXOSMITHKLINEUS202116	2	08/05/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1531250	08/06/2021	MD	17.0	17		M		administrated with Bexsero after a below freezing temperature excursion; This case was reported by a physician via call center representative and described the occurrence of incorrect storage of drug in a 17-year-old male patient who received Men B NVS (Be									U	07/19/2021				UNK		Bexsero Pre-Filled Syringe Device				USGLAXOSMITHKLINEUS202116	2	08/06/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1532270	08/06/2021	MD	17.0	17		M		After receiving the vaccine, patient walked to a chair and sat down about 10 feet away. His father was right next to him. Right away the father ran over to the pharmacy counter saying something's wrong with his son. When I(pharmacist) looked up I saw hi									U	08/06/2021	08/06/2021	0	Medics checked his vitals that showed normal	PHM		none known	none	none			2	08/06/2021			Y	none	2021VAERSSYMPTOMS	2021VAERSVAX
1533938	08/07/2021	MD	17.0	17		M		below freezing temperature excursion; This case was reported by a physician via call center representative and described the occurrence of incorrect storage of drug in a 17-year-old male patient who received HAV (Havrix) (batch number yl532, expiry date 9t									U	07/19/2021				UNK						USGLAXOSMITHKLINEUS202116	2	08/05/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1534865	08/07/2021	MD	17.0	17		F		the patient was given higher than recommended dose because of error in mixing the vaccine with the diluent. the vaccine was only mixed with 0.8ml of the diluent instead of 1.8ml of the diluent resulting in concentrated form of the vaccine.									U	08/07/2021	08/07/2021	0		PHM		no known	no	no			2	08/07/2021				no	2021VAERSSYMPTOMS	2021VAERSVAX
1535337	08/08/2021	MD	17.0	17		F		Woke up at 2 am with extreme pain in my chest and shortness of breath. Then my stomach started burning and burned all the way up to my chest and then throat until I had to throw up. I threw up a bunch of green liquid that really burned my throat. I took									Y	08/04/2021	08/05/2021	1		PHM		Birth control	None	None			2	08/08/2021				None	2021VAERSSYMPTOMS	2021VAERSVAX
1546349	08/11/2021	MD	17.0	17		F		After I got vaccinated, I was fine for about five minutes. Then, my hands got all tingly and numb. My shoulders both got really hot and I sweated profusely despite being in the car driving home. When I got home, it hurt to the touch. The next day, nothing										08/09/2021	08/09/2021	0		PVT		None	None	None			2	08/11/2021				Amoxicillin, Pollen, Mold, Mosquito bites	2021VAERSSYMPTOMS	2021VAERSVAX
1549035	08/12/2021	MD	17.0	17		F		There was an administration error today (8/11) . Individual is under 18 years old.									Y	08/11/2021	08/11/2021	0		PVT							2	08/12/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1549235	08/12/2021	MD	17.0	17		F		Experienced a red dot rash approximately 2 weeks before visited pediatrician and blood work was done. The rash was diagnosed as petechaie at Pediatrics on August 7, 2021. The next day we received a call that a critical message was sent regarding my daugh									N	05/09/2021	07/21/2021	73	Platelet count 5,000 8/7/2021 Platelet count 18,000 8/8/2021 Platelet count 3,000 8/10/2021	OTH		Lexapro, Wellbutrin, Lo Lo Estrin	None	Asthma			2	08/12/2021		Y	Y	Pollen, cats	2021VAERSSYMPTOMS	2021VAERSVAX
1558451	08/14/2021	MD	17.0	17		M		Janssen shot administered to 17 Year old.									Y	08/14/2021	08/14/2021	0		UNK		N/A	N/A	N/A			2	08/14/2021				N/A	2021VAERSSYMPTOMS	2021VAERSVAX
1567023	08/15/2021	MD	17.0	17		M		17-year-old patient received first dose of the Moderna Vaccine; A spontaneous report was received from a nurse concerning a 17-year-old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273). The patient's medical history was not provided. No r									Y	02/11/2021	02/11/2021	0		UNK				Medical History/Concurrent Conditions: No adverse event (No medical history reported.)		USMODERNATX, INC.MOD20210	2	08/11/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1608359	08/22/2021	MD	17.0	17		F		17 years old daughter received the Moderna Vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (17 years old daughter received the Moderna Vaccine) in a 17-year-old									U	04/16/2021	04/16/2021	0		UNK		LEXAPRO		Comments: No medical history was provided		USMODERNATX, INC.MOD20210	2	08/12/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1612278	08/22/2021	MD	17.0	17		F		inappropriate age at vaccine administration; This spontaneous case was reported by a physician (subsequently medically confirmed) and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (inappropriate age at vaccine administrat									U	03/31/2021	03/31/2021	0		UNK						USMODERNATX, INC.MOD20210	2	08/13/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1617629	08/22/2021	MD	17.0	17		F		new onset diabetes, Diabetic Ketoacidosis pt being transferred to medical center- f/u there unknown how many days she may be admitted, i put 2 days on the admitted line due to unknown how long she will be admitted.			Y		Y	2		Y	N	08/20/2021	08/21/2021	1	glucose 398, pH 7.2, d-dimer 1.3	PVT		no known	no known	no known			2	08/22/2021			Y	No known	2021VAERSSYMPTOMS	2021VAERSVAX
1620962	08/23/2021	MD	17.0	17		F		arm was sore; 17 years old at the time of vaccination; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (17 years old at the time of vaccination) and PAIN IN EXTREMITY (ar									Y	01/13/2021	01/13/2021	0		UNK						USMODERNATX, INC.MOD20211	2	08/15/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1662929	09/01/2021	MD	17.0	17		F		17 year old given Moderna vaccination. No signs and symptoms of adverse event during observation period of 15 minutes after injection.										09/01/2021	09/01/2021	0		SEN							2	09/01/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1714144	09/19/2021	MD	17.0	17		F		About 10 minutes post vaccination, patient started experiencing labored breathing, headache and slight chest pain. Mother of patient also stated patient has history of anxiety.									U	09/19/2021	09/19/2021	0		PUB		albuterol hfa inhaler	n/a	asthma			2	09/19/2021			Y	n/a	2021VAERSSYMPTOMS	2021VAERSVAX
1757891	10/04/2021	MD	17.0	17		F		Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild.									Y	10/03/2021	10/03/2021	0		PHM							2	10/04/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1768300	10/07/2021	MD	17.0	17		F		Patient made appointment for Pfizer covid 19 booster shot and received vaccine. However he is 17 and is not indicated for booster shot.										10/03/2021	10/03/2021	0		UNK							2	10/07/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1779162	10/12/2021	MD	17.0	17		M		Pneumothorax (Several seen during surgery) Surgery to correct pneumothorax Enlarged right atrium still under investigation					Y	11			N	05/08/2021	09/17/2021	132	Several EKGs One upon admittance to the hospital on 9/18/2021 and one on release 9/29/2021	PVT		none	none	none			2	10/12/2021		Y	Y	oxycodone	2021VAERSSYMPTOMS	2021VAERSVAX
1842642	11/04/2021	MD	17.0	17		F		Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-									Y	11/02/2021	11/02/2021	0		PHM							2	11/04/2021					2021VAERSSYMPTOMS	2021VAERSVAX
1853648	11/09/2021	MD	17.0	17		F		Pharmacist did not realize that patient was only 17 years old at the time of vaccination. Mother accompanied patient and thought that the patient qualified for the booster. It wasn't until other pharmacist went to bill after administration that it was disc									Y	11/09/2021	11/09/2021	0	None	PHM		None reported	None reported	None reported			2	11/09/2021				None known	2021VAERSSYMPTOMS	2021VAERSVAX