VAERS ID: 2057562

AGE: 15| SEX: M|State: ID

Description

Vaccine Administration Error: 15 yo male received incorrect formulation (5 -11 years of age formulation 0.2 ml (orange cap)) for second dose of Pfizer-BioNTech COVID-19 vaccine. Patient should have received adult Pfizer dose 0.3ml. Patient did NOT experience an adverse reaction.

Symptoms

Adverse reaction, Incorrect product formulation administered

Vaccines

VAX DATE: 27 December 2021 | ONSET DATE: 27 December 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        21 January 2022
        CAGE_YR:
        15
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        LAB_DATA:
        This is a Vaccine Administration Error report, patient did NOT experience an adverse reaction.
        V_ADMINBY:
        PVT
        OTHER_MEDS:
        None
        CUR_ILL:
        HISTORY:
        Migraine Headache without Aura Sleep Disorder
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        21 January 2022
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        NKDA
        V_FUNDBY: