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This is VAERS ID 1330587

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330587
VAERS Form:2
Age:16.0
Sex:Female
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, Incorrect product formulation administered

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: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

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

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