Report #2830158

Received Mar 7, 2025

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 11 yrs
State: ND
Recovered: Recovered
Vaccinated: Mar 6, 2025
Onset: Mar 6, 2025
Days to onset: 0
Hospital days: —

Vaccines (5)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	b0001	IM / LA
FLU3	INFLUENZA (SEASONAL) (FLULAVAL)	GLAXOSMITHKLINE BIOLOGICALS	N/A	79ky5	IM / LA
HPV9	HPV (GARDASIL 9)	MERCK & CO. INC.	1	y008119	IM / LA
MNQ	MENINGOCOCCAL CONJUGATE (MENQUADFI)	SANOFI PASTEUR	1	u8361aa	IM / RA
TDAP	TDAP (BOOSTRIX)	GLAXOSMITHKLINE BIOLOGICALS	1	m7yy5	IM / RA

Symptoms (1)

Product administered to patient of inappropriate age

Symptom narrative

Patient was administered Moderna covid vaccine for ages 12+ . Patient should have had Moderna covid vaccine for 6 months to 11 years. Patient and family were educated on vaccine, potential side effects, and adverse effects to be aware of and monitor. Talked with mother of patient who states that patient only has a sore arm. no other side effects or concerns at this time. Primary care provider was updated along with supervising staff per protocol. Manufacturer updated and discussed potential side effects. Dose will not be readministered. No change in treatment for this patient.

Current illness

none

Medical history

ADHD, Autism, tongue anomaly, congenital, speech articulation disorder

Other medications

strattera, Multivitamin, zoloft

Allergies

seasonal

Lab data

non indicated at this time per PCP.