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This is VAERS ID 1758627

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1758627
VAERS Form:2
Age:77.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Incorrect dose administered, No adverse event

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: empagliflozin (JARDIANCE) 10 MG tablet Take 1 tablet by mouth daily (before breakfast). nitrofurantoin, macrocrystal-monohydrate, (MACROBID) 100 MG capsule Take 1 capsule by mouth 2 times daily for 10 days. AMIODarone (PACERONE) 200 MG tabl
Current Illness: none
Preexisting Conditions: Coronary atherosclerosis of unspecified type of vessel, native or graft Essential hypertension, benign Hyperlipidemia Status post abdominal aortic aneurysm repair PVD (peripheral vascular disease) (CMS/HCC) Atrial fibrillation with RVR (CMS/HCC) Wide-complex tachycardia (CMS/HCC) Endocrine and Metabolic Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled Eye Exophthalmos Myopia Old retinal detachment, partial Presbyopia Genitourinary and Reproductive Elevated PSA Impotence of organic origin
Allergies: nka
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient recieved 1.3ml pfizer vaccine instead of the 0.3ml thus far patient has not had any adverse reaction to the increased dose given

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