VAERS ID: 1849528

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

Description

father of patient scheduled the faxing for patient with the wrong date of birth 10/31/2008 instead 10/31/2010. Per father, he mixed up birthdates for his two sons and as a result patient was administered adult Pfizer dose of 0.3ml instead of pediatric Pfizer dose of 0.2ml. Wrong vaccine. Patient was doing good after 15 minutes of monitoring and a follow up call on 11/07/2021 with his Father.

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Symptoms

Incorrect dose administered, No adverse event

Vaccines

VAX DATE: 11-06-2021| ONSET DATE: 11-06-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FF2593 IM LA

RECVDATE:11-07-2021
RPT_DATE:
CAGE_YR:11
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:None done
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-07-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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