VAERS ID: 1862527

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

Description

Child was given an undiluted dose of Pediatric Pfizer vaccine. Discussed situation with medical director - determination was that no medical intervention was necessary. PHN supervisor contact the parent via phone call (translation used), guardian advised of administration of undiluted Pfizer pediatric vaccine. Guardian advised that no medical intervention was needed, reviewed when to contact emergency care if needed. Guardian reported that child was experiencing no adverse events after vaccination. Provided PHN's name and phone number if questions/concerns arose.

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Symptoms

No adverse event, 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)) 1 COVID19 PFIZER\BIONTECH FK5127 IM LA

RECVDATE:11-11-2021
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:
V_ADMINBY:PUB
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:4001
FORM_VERS:
TODAYS_DATE:11-11-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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