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VAERS ID: 1944478

AGE: 11| SEX: M|State: TX

Description

Pediatric dose volume (0.2ml) was drawn up from Adult Pfizer vial. The 11 year-old patient received 0.2 ml of the 12+ Pfizer vaccine. The parents of the patient were notified as soon as it was discovered and told to monitor child for adverse effects.

Symptoms

Incorrect dose administered

Vaccines

VAX DATE: 01 December 2021 | ONSET DATE: 01 December 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 2
  • IM
  • LA
  • 30145BA

RECVDATE:12 December 2021
CAGE_YR:11
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:Y
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:09 December 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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