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This is VAERS ID 1330975

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1330975
VAERS Form:2
Age:15.0
Sex:Male
Location:New York
Vaccinated:2005-06-02
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 EW0183 / 1 LA / IM

Administered by: Public      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: N/A
Current Illness: Upper respitory infection
Preexisting Conditions: N/a
Allergies: Shell Fish
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: When administering the vaccine the needles detached from the syringe causing the vaccine to not enter the patient.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330975&WAYBACKHISTORY=ON


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