VAERS ID: 1861437

AGE: 8| SEX: M|STATE: CA (United States)

Description

Pediatric patient was given 0.3 mL of COVID vaccine from Adult/teen formulation. Patient was monitored for 15 minutes with no allergic reactions noted. Accident was discovered 1 hour after vaccine given. Family has been notified. He is currently being monitored for symptoms.

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Symptoms

Incorrect dose administered, Incorrect product formulation administered

Vaccines

VAX DATE: 11-11-2021| ONSET DATE: 11-11-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 0 COVID19 PFIZER\BIONTECH FE3590 IM RA

RECVDATE:11-11-2021
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:PVT
OTHER_MEDS:None
CUR_ILL:None
HISTORY:None
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-11-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:No known drug allergies
V_FUNDBY:

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