VAERS ID: 1984674

AGE: 16| SEX: M|STATE: MI (United States)

Description

Booster show was administered by MA staff, realized the vaccine had expired. Date vaccine was pulled from freezer was 11/24/21 with an expiration of 12/24/2021. Vaccine was given on 12/28/2021 at 0830 AM, contacted Pfizer recommended re-vaccination of patient. Patient waited the 15 minutes as advised after receiving the vaccine, no adverse effected noted during this time. Patient and mother aware of expired vaccine.

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Symptoms

No adverse event, Expired product administered

Vaccines

VAX DATE: 12-28-2021| ONSET DATE: 12-28-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH FJ1620 IM LA

RECVDATE:12-28-2021
RPT_DATE:
CAGE_YR:16
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-28-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:nkda
V_FUNDBY:

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