VAERS ID: 1851373

AGE: 7| SEX: F|STATE: AZ (United States)

Description

On 11/06/2021 patient was administered 0.3 ml, Intramuscular of the adult Pfizer Biontech COVID19 vaccine. Mother and Physician where aware of incident at the time. Patient was monitored 15 minutes after injection. Patient did not have any adverse reaction to vaccine. On 11/08/2021 I called Mother and she stated patient is doing well. Patient only complained of pain on the arm of the injection site on day one. Denies fever, fatigue, and headaches. Overall condition, is stable. Our office has taken measures and separated the vaccine for the adults and children. Reviewed Pfizer-Biontech "Standing Orders for Administering Vaccine" and have purchased additional orange round labels to place on syringes.

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Symptoms

Injection site pain

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 30145BA SYR RA

RECVDATE:11-08-2021
RPT_DATE:
CAGE_YR:7
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:NONE
V_ADMINBY:PVT
OTHER_MEDS:NONE
CUR_ILL:NONE
HISTORY:NONE
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-08-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:AMOXICILLIN
V_FUNDBY:

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