VAERS ID: 1858202

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

Description

Patient was given the 12+ version of vaccine. Made to wait 30 min post vaccine. The health director was called. Expecting no abnormal outcomes.

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Symptoms

Incorrect dose administered

Vaccines

VAX DATE: 11-10-2021| ONSET DATE: 11-10-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH ew0191 IM RA

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:U
LAB_DATA:
V_ADMINBY:PUB
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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