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This is VAERS ID 1843071

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History of Changes from the VAERS Wayback Machine

First Appeared on 11/5/2021

VAERS ID: 1843071
VAERS Form:2
Age:10.0
Sex:Male
Location:D.C.
Vaccinated:2021-11-03
Onset:2021-11-03
Submitted:0000-00-00
Entered:2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: On 11/3/2021, Medical assistant administered incorrect vaccine type-dose. Patient received incorrect vaccine type-dose for his age. Patient was to receive Covid-19 Pfizer Pediatric dose (0.2ml) and instead received the wrong dose of Covid-19 Pfizer dose for 12 years old and up. RN followed up with parents and they voiced understanding of the error during vaccine administration and reported patient was doing well. They agreed to monitor child for any side effect and call us to report concern.

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