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VAERS ID: 1696757

AGE: 11| SEX: F|State: GA

Description

Patient was 11 years old and 8 months at the time of vaccine No side effects noted.

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 13 September 2021 | ONSET DATE: | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • IM
  • LA
  • FA6780

RECVDATE:13 September 2021
CAGE_YR:11
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:U
LAB_DATA:None
V_ADMINBY:PVT
OTHER_MEDS:None
CUR_ILL:None
HISTORY:None
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:13 September 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:None
V_FUNDBY:
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