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This is VAERS ID 1701108

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1701108
VAERS Form:2
Age:53.0
Sex:Male
Location:Virginia
Vaccinated:2021-09-10
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain in extremity, Incorrect dose administered, No adverse event, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given the entire vial of the undiluted Pfizer Covid vaccine. I spoke with the patient and he stated that he only had a sore arm on 9/11/21. He has no other adverse effects.

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