2057562

thumb
Adverse reaction, Incorrect product formulation administered
VAERS_ID:
2057562
CATEGORY:
2022
RECVDATE:
21 January 2022
STATE:
ID
AGE_YRS:
15.00
CAGE_YR:
15
CAGE_MO:
SEX:
M
RPT_DATE:
SYMPTOM_TEXT:
Vaccine Administration Error: 15 yo male received incorrect formulation (5 -11 years of age formulation 0.2 ml (orange cap)) for second dose of Pfizer-BioNTech COVID-19 vaccine. Patient should have received adult Pfizer dose 0.3ml. Patient did NOT experience an adverse reaction.
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
VAX_DATE:
27 December 2021
ONSET_DATE:
27 December 2021
NUMDAYS:
0
LAB_DATA:
This is a Vaccine Administration Error report, patient did NOT experience an adverse reaction.
V_ADMINBY:
PVT
V_FUNDBY:
OTHER_MEDS:
None
CUR_ILL:
HISTORY:
Migraine Headache without Aura Sleep Disorder
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
21 January 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
NKDA
VAX_TYPE:
COVID19
VAX_MANU:
PFIZER\BIONTECH
VAX_LOT:
FK5127
VAX_DOSE_SERIES:
2
VAX_ROUTE:
IM
VAX_SITE:
LA
VAX_NAME:
COVID19 (COVID19 (PFIZER-BIONTECH))