VAERS ID: 1536184

AGE: 11| SEX: M|STATE: MN

Description

Patient's parent/guardian made an online appointment with the DOB as 11/17/2008. At appointment, parent was asked if patient had insurance and was told no. Vaccine was processed under "cash" payment and vaccine was given to patient. Upon entering the vaccine into the MN Immunization data base (MIIC), it was entered under the actual DOB of 2009, which flagged that patient was underage. Pharmacist spoke with patient's father who brought him to vaccine appointment and he was not sure of patient's actual birthdate but when told he was not yet 12 years old he apologized and said a different adult in the household made the appointment.

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 08-06-2021| ONSET DATE: 08-09-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FA7484 IM LA

RECVDATE:08-09-2021
RPT_DATE:
CAGE_YR:11
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:08-09-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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