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This is VAERS ID 1330546

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330546
VAERS Form:2
Age:16.0
Sex:Male
Location:New York
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / IM

Administered by: School      Purchased by: ??
Symptoms: No adverse event, Product preparation issue

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: no adverse reaction as of this time. wrong dilution of vaccine (1.3 ml vs. 1.8 ml) monitor only, no treatment . reported to health office

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