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This is VAERS ID 1392402

History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1392402
VAERS Form:2
Age:47.0
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 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Incorrect product formulation administered, Product use 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The vaccine was mixed using a multi-dose vial of diluent. The diluent vial was punctured twice and used to mix two vials of vaccine. The injection was given IM but a 5/8 inch needle may have been used.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1392402&WAYBACKHISTORY=ON


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