VAERS ID: 1752999

AGE: 71| SEX: M|STATE: MI (United States)

Description

Patient was erroneously given undiluted vial of Pfizer COVID vaccine, equivalent to 5-6 doses. Was monitored in clinic for 1.5 hours afterward with stable q15m vitals. Patient felt clammy but otherwise no side effects.

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Symptoms

Cold sweat, Incorrect dose administered, Product preparation issue

Vaccines

VAX DATE: 09-30-2021| ONSET DATE: 09-30-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) 1 FLU4 SANOFI PASTEUR UJ715AB SYR RA
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH EW0179 SYR LA

RECVDATE:10-01-2021
RPT_DATE:
CAGE_YR:71
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:aspirin, atenolol, dulcolax, fenofibrate, lasix, PRN neurontin, glimepiride, ketoconazole cream, lisiniopril, lovastatin, metformin XR, PRN nitroglycerin, omeprazole, zofran, K-dur, flomax, kenalog cream, maxzide
CUR_ILL:
HISTORY:chronic DM, HTN, HLD, neuropathy, back pain
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-01-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKDA
V_FUNDBY:

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