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This is VAERS ID 1367826

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367826
VAERS Form:2
Age:57.0
Sex:Female
Location:Montana
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Incorrect dose 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given an undiluted COVID-19 vaccine (Pfizer). Medication was given with no diluent to dilute the vaccine vial and 0.3 mL of the vial contents were administered to the patient.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367826&WAYBACKHISTORY=ON


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