VAERS ID: 1861805

AGE: 9| SEX: M|STATE: PR (United States)

Description

Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. Patient presented severe pain at inyection site and could not raise the arm for 48 hours

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Symptoms

Injection site pain, Injected limb mobility decreased, Incorrect product formulation administered

Vaccines

VAX DATE: 11-06-2021| ONSET DATE: 11-06-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5618 IM LA

RECVDATE:11-11-2021
RPT_DATE:
CAGE_YR:9
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:11-11-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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