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This is VAERS ID 1378186

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378186
VAERS Form:2
Age:15.0
Sex:Male
Location:Texas
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Needle 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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: During an injection procedure, syringe came dislodged from the needle. It was determined by the vaccinator that majority of the vaccine had been injected. No additional dose was given.

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