VAERS ID: 1860557

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

Description

By inadvertent mistake, the Pfizer BioNTech vaccine vial was diluted with 0.3ml 0.9% Sodium Chloride instead of 1.3ml. The dose administered to the patient was 0.2ml after dilution.

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Symptoms

Incorrect dose administered, Product preparation error

Vaccines

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

RECVDATE:11-11-2021
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:
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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