National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1723603

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1723603
VAERS Form:2
Age:27.0
Sex:Male
Location:California
Vaccinated:2021-09-13
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Product reconstitution quality 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 disclosed.
Current Illness: None disclosed.
Preexisting Conditions: None disclosed.
Allergies: None disclosed.
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Patient received a higher concentration dose of Pfizer COVID-19 Vaccine. Dilution of vial was done with 1.3mL of NS. Only this patient affected. Rest of vial was discarded. Patient did NOT experience any adverse S/S during 45-minute observation at field site. No concern by Lead RN for release. Patient verbalized feeling OK before release.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1723603&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166