VAERS ID: 1971385

AGE: 15| SEX: M|STATE: AZ

Description

Patient presented for an immunization clinic with his 17 year old sibling and father. This vaccinator did give the 3rd Covid vaccine to the patient. It was not until afterward when charting that I realized the patient was 15 years old. My Lead nurse was informed immediately afterward and an attempt to contact the parent was made.

Symptoms

Product administered to patient of inappropriate age

Vaccines

VAX DATE: 12-21-2021| ONSET DATE: 12-21-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH FJ8757 IM RA

RECVDATE:12-22-2021
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:n/a
V_ADMINBY:PVT
OTHER_MEDS:n/a
CUR_ILL:n/a
HISTORY:n/a
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:12-22-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKDA
V_FUNDBY:

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