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This is VAERS ID 1346690

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1346690
VAERS Form:2
Age:11.0
Sex:Male
Location:Unknown
Vaccinated:2021-05-22
Onset:2021-05-22
Submitted:0000-00-00
Entered:2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was booked by his family in system as his 13 year old sister. Information was changed at vaccine site to this patient who was only 11 years 5 months old. This was not caught until after the patient received his shot. We aware of any untoward effects. Patient''s mother was informed this would be reported to the DPH and CDC. Patient''s mother indicated she was aware he was not eligible at this time. This was her second attempt to get him vaccinated as he was turned away at a previous clinic.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1346690&WAYBACKHISTORY=ON


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