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This is VAERS ID 1437705

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1437705
VAERS Form:2
Age:46.0
Sex:Male
Location:Texas
Vaccinated:2021-06-29
Onset:2021-06-29
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Incorrect dose administered, No adverse event, Incorrect product formulation administered, Product preparation error

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient received dose 1 of an undiluted Pfizer Vaccine. ( 6 times the dose). Patient reported no adverse effects after 24 hours

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1437705&WAYBACKHISTORY=ON


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