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This is VAERS ID 1391999

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1391999
VAERS Form:2
Age:45.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / 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: The vaccine was prepared with a multi-dose vial of diluent. The diluent vial was punctured twice to mix two different vials of vaccine. The dose of medication may have been given IM with a 5/8 inch needle.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1391999&WAYBACKHISTORY=ON


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