VAERS ID: 1880521

AGE: 4| SEX: F|STATE: MN (United States)

Description

Patient falsified DOB when registering for vaccination, stating the minor was 05/16/2017. Guardian, consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB is 05/16/2017 which made the vaccine a contraindication. No known adverse reactions noted.

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

No adverse event, Circumstance or information capable of leading to medication error, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 11-13-2021| ONSET DATE: 11-13-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 IM LL

RECVDATE:11-18-2021
RPT_DATE:
CAGE_YR:4
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PUB
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-18-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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