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This is VAERS ID 1438943

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1438943
VAERS Form:2
Age:14.0
Sex:Male
Location:Florida
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 E38733 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: No adverse event, Product preparation issue

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none at this time
CDC 'Split Type':

Write-up: No symptoms no adverse effects. Incorrect reconstitution of complete vial. Diluent applied to vial 0.8 of saline instead of recommended 1.8ml as directed Patient received correct dose of 0.3ml Parent instructed to contact clinic if symptoms arise and to go to ER if life threatening symptoms occur.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1438943&WAYBACKHISTORY=ON


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