VAERS ID: 1856927

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

Description

Undiluted Pfizer COVID 19 vaccination for patients age 5-11 was administered. 0.2ml of undiluted vaccine was administered to the patient. Patient was monitored for over 15 minutes with no adverse reaction. Followed up with the patient 6 hours later and patient was still without any adverse reaction. Manufacturer was contacted and sent guidelines stating that dose did not need to be re-administered and may receive 2nd dose 21 days after.

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Symptoms

No adverse event, Product preparation issue

Vaccines

VAX DATE: 11-09-2021| ONSET DATE: 11-09-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 IM LA

RECVDATE:11-10-2021
RPT_DATE:
CAGE_YR:11
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-10-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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