VAERS ID: 1843687

AGE: 10| SEX: M|STATE: CO (United States)

Description

Adult dose Pfizer given to 10-year, 8-month-old patient in error at mobile clinic site: 0.3mL of COVID-19 mRNA (PFR). The patient should have received the pediatric dose of the Pfizer vaccine. This was the first vaccine in the series. The father was present with the patient and notified via phone. Father states patient is doing well and is not experiencing any side effects.

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Symptoms

Extra dose administered, No adverse event

Vaccines

VAX DATE: 11-03-2021| ONSET DATE: 11-03-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FE3592 IM LA

RECVDATE:11-04-2021
RPT_DATE:
CAGE_YR:10
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PUB
OTHER_MEDS:
CUR_ILL:None reported
HISTORY:Not applicable - not assessed
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:None reported
V_FUNDBY:

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