VAERS ID: 1852026

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

Description

Pt was a large 11years 7 month old male, was registered with correct date of birth, as under 12 years, but pt and mother went to the adult section, and subsequently received an adult (12 and over) dose of pfizer instead of the pediatric dose. Pt's mother noted to the staff that she wanted her large for his age son to get an adult dose. Unclear if she purposefully went to the adult area. There was NO adverse reactions.

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Symptoms

Incorrect dose administered, No adverse event

Vaccines

VAX DATE: 11-07-2021| ONSET DATE: 11-07-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH 320308D IM AR

RECVDATE:11-08-2021
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
V_ADMINBY:PUB
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:none
V_FUNDBY:

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