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This is VAERS ID 1752999

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First Appeared on 10/1/2021

VAERS ID: 1752999
VAERS Form:2
Age:71.0
Sex:Male
Location:Michigan
Vaccinated:2021-09-30
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ715AB / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cold sweat, Incorrect dose administered, Product preparation issue

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: aspirin, atenolol, dulcolax, fenofibrate, lasix, PRN neurontin, glimepiride, ketoconazole cream, lisiniopril, lovastatin, metformin XR, PRN nitroglycerin, omeprazole, zofran, K-dur, flomax, kenalog cream, maxzide
Current Illness:
Preexisting Conditions: chronic DM, HTN, HLD, neuropathy, back pain
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was erroneously given undiluted vial of Pfizer COVID vaccine, equivalent to 5-6 doses. Was monitored in clinic for 1.5 hours afterward with stable q15m vitals. Patient felt clammy but otherwise no side effects.

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