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This is VAERS ID 1694079

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1694079
VAERS Form:2
Age:16.0
Sex:Male
Location:Missouri
Vaccinated:2021-09-13
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Expired product administered

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:
CDC 'Split Type':

Write-up: Patient was given immunization 1 hour beyond 6 hour puncture beyond use time frame

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