VAERS ID: 2327621

AGE: 81| SEX: M|STATE: CA

Description

Vaccine administering error: At our COVID vaccination clinic, patient was accidentally given Moderna COVID vaccine (18 and up) 0.3 ml instead of 0.25ml as the 2nd COVID vaccine booster. Patient was contacted the same day and notified this vaccine administering error. Then patient was contacted again the next day to follow up. Patient did not have any other signs or symptoms except pain in the injection site.

Symptoms

Extra dose administered, Injection site pain, Wrong product administered

Vaccines

VAX DATE: 05-12-2022| ONSET DATE: 05-12-2022| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 4 COVID19 MODERNA 056M21A IM LA

RECVDATE:06-22-2022
RPT_DATE:
CAGE_YR:81
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:None.
V_ADMINBY:PVT
OTHER_MEDS:04/05/2022 ASPIRIN EC 81 mg 90 TAKE 1 TABLET BY MOUTH ONCE DAILY. 04/05/2022 HYDROCHLOROTHIAZIDE 12.5 mg 90 TAKE 1 CAPSULE BY MOUTH ONCE DAILY. 04/05/2022 GLIPIZIDE ER 5 mg 90 Take 1 tablet by mouth every day with breakfast 01/11/2022 NATUR
CUR_ILL:None
HISTORY:Benign essential hypertension Hyperlipidemia History of cerebrovascular accident with residual deficit CKD stage G3a/A2, GFR 45-59 and albumin creatinine ratio 30-299 mg/g Left-sided weakness Type 2 diabetes mellitus without complication Vitamin D deficiency Depression, unspecified depression type Adjustment disorder with depressed mood Benign prostatic hyperplasia Hemiparesis Minimal cognitive impairment
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:06-22-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:No Known Allergies.
V_FUNDBY:

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