VAERS ID: 1889636

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

Description

Parent wrote that patient's age was: 03/24/2016 when in fact, the child was born on 03/24/2017 (per Database). This date modification was noted after the immunization was given. Several attempts have been made to contact Parent via phone, but our office is unable to leave a message and/or Parent does not answer her phone. A letter will be sent from the Immunization Coordinator to Parent addressing this concern. No adverse reaction has been reported to Immunization Clinic about Patient's Pfizer Covid #1 vaccination.

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Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 11-05-2021| ONSET DATE: 11-05-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5127 IM LA

RECVDATE:11-22-2021
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:11-22-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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