VAERS ID: 1858168

AGE: 10| SEX: M|STATE: MO (United States)

Description

Pt was administered a dose of 0.2ml that was drawn from the adult dose vials.

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Symptoms

Extra dose administered

Vaccines

VAX DATE: 11-08-2021| ONSET DATE: 11-08-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH 320308d IM LA

RECVDATE:11-10-2021
RPT_DATE:
CAGE_YR:10
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:none medically necessary at this time
V_ADMINBY:PVT
OTHER_MEDS:none reported
CUR_ILL:none reported
HISTORY:none reported
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-10-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:nka
V_FUNDBY:

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