Report #2893088

Received Apr 17, 2026

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: Female
Age: 10 yrs
State: MA
Recovered: Unknown
Vaccinated: Apr 15, 2026
Onset: Apr 16, 2026
Days to onset: 1
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	3052741	IM / RA
FLU3	INFLUENZA (SEASONAL) (FLULAVAL)	GLAXOSMITHKLINE BIOLOGICALS	1	724TF	IM / RA

Symptoms (2)

No adverse eventProduct administered to patient of inappropriate age

Symptom narrative

Patient was administered a 12+ COVID vaccine. PCP, mother, and charge nurse were notified. Per PCP, no intervention is required at this time; patient is expected to remain stable. No adverse reaction noted. Advise mother for any question or concern contact office verbalize understanding.

Current illness

"Mild intermittent asthma without complication Intermittent abdominal pain Intermittent over the past year, sometimes in epigastric area, other times generalized. Denies constipation. Does take OTC omeprazole with some improvement occasionally."

Medical history

Mild intermittent asthma without complication Intermittent abdominal pain

Other medications

albuterol HFA 90 mcg/actuation inhaler Fluticasone (FLONASE) 50 mcg/actuation nasal spray fluticasone propionate (FLOVENT HFA) 44 mcg/actuation inhaler

Allergies

House Dust Not Specified Pollen Extracts Not Specified

Lab data

N/A