VAERS ID: 1855575

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

Description

Patient stated DOB as 10/14/2009 on the consent release forms. So we trusted the parent not realize the child is under 12

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

Product administered to patient of inappropriate age

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 FH8020 IM LA

RECVDATE:11-09-2021
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:
V_ADMINBY:PHM
OTHER_MEDS:n/a
CUR_ILL:n/a
HISTORY:n/a
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-09-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:nka
V_FUNDBY:

Questions? Comments? Bugs?
[email protected]
Due to the high volume of inquiries, please be patient with response times.

AND PLEASE read the FAQ first.

OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.