VAERS ID: 1984674

AGE: 16| SEX: M|STATE: MI

Description

Booster show was administered by MA staff, realized the vaccine had expired. Date vaccine was pulled from freezer was 11/24/21 with an expiration of 12/24/2021. Vaccine was given on 12/28/2021 at 0830 AM, contacted Pfizer recommended re-vaccination of patient. Patient waited the 15 minutes as advised after receiving the vaccine, no adverse effected noted during this time. Patient and mother aware of expired vaccine.

Symptoms

Expired product administered, No adverse event

Vaccines

VAX DATE: 12-28-2021| ONSET DATE: 12-28-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH FJ1620 IM LA

RECVDATE:12-28-2021
RPT_DATE:
CAGE_YR:16
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:12-28-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:nkda
V_FUNDBY:

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