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This is VAERS ID 1483335

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1483335
VAERS Form:2
Age:12.0
Sex:Male
Location:Kansas
Vaccinated:2021-07-01
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Overdose, Product preparation error

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': USPFIZER INC2021822779

Write-up: received undiluted doses of the vaccine; received undiluted doses of the vaccine; This is a spontaneous report from a contactable physician reported same events under the same suspect product for 4 patients. This is three of 4 reports. A 12-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: solution for injection, lot number: EW0179; expiration date: Aug2021), dose 2 via an unspecified route of administration, administered in left arm on 01Jul2021 (at the age of 12 years), as 0.3 ml single dose for COVID-19 immunisation. The patient had no medical history. The patient did not receive other products. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: solution for injection, lot number and expiration date were not reported), administered on an unknown date, as single dose for COVID-19 immunisation. On 01Jul2021, patient received undiluted 0.3 ml dose of the vaccine. The physician reported as serious. Outcome of an events was unknown. ; Sender''s Comments: Based on the information in the case report and a plausible temporal relationship, a possible causal relationship between the serious event "overdose"and suspect drug BNT162B2 cannot be excluded.,Linked Report(s) : US-PFIZER INC-2021822170 Same reporter/product/event, different patient

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