VAERS ID: 1846825

AGE: 10| SEX: F|STATE: HI (United States)

Description

Administered 0.2mL of Adult Pfizer COVID-19 formulation instead of 0.2mL of Pediatric. Pfizer COVID-19 formulation.

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Extra dose administered, Wrong product administered

Vaccines

VAX DATE: 11-05-2021| ONSET DATE: 11-05-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FJ8027 IM LA

RECVDATE:11-05-2021
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:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-05-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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