VAERS ID: 1857948

AGE: 8| SEX: F|STATE: GA (United States)

Description

No adverse event. This was an administration error. Mother brought in child for vaccine. She listed DOB having the patient listed at 13 years old. After adult vaccine (12+ years/Purple Cap) vaccine was administered, mom realized the DOB was incorrect on the COVID card. She had accidentally given us the DOB of her other child. When we updated the DOB in the pharmacy system, we then realized the child was 8 years old and should have received the Pediatric COVID vaccination. The child is not experiencing any side effects from the adult vaccination per a phone call with the mother today at 10am.

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Symptoms

No adverse event, Product administered to patient of inappropriate age

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 ff2590 IM LA

RECVDATE:11-10-2021
RPT_DATE:
CAGE_YR:8
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:
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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