VAERS ID: 1793853

AGE: 11| SEX: M|STATE: KY (United States)

Description

Patient was intended to receive a Flu shot and was administered a Covid Pfizer vaccine. Patients mom made aware and wanted patient to receive this vaccine but he does not turn 12 for a few weeks. Right on the edge of the approved guidelines. No adverse reactions at this time. will follow up tomorrow

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Symptoms

Interchange of vaccine products, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 10-16-2021| ONSET DATE: 10-16-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH 32030bd IM RA

RECVDATE:10-16-2021
RPT_DATE:
CAGE_YR:11
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:none
CUR_ILL:none
HISTORY:none
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-16-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:none
V_FUNDBY:

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