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This is VAERS ID 1759224

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759224
VAERS Form:2
Age:72.0
Sex:Male
Location:Iowa
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 FC3183 / 4 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Extra 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: unknown
Current Illness: unknown
Preexisting Conditions: Alzheimers Disease
Allergies: Erythromycin
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: COVID vaccine clinic for third dose held for residents at the HCF on 10/4/2021. Facility Director of Nursing took Public Health Staff around to resident''s rooms to administer vaccine. Director of Nursing had already completed the paper forms ahead of time. This resident was inadvertently given a fourth dose of the pfizer covid vaccine and it wasn''t discovered until entering the information into the immunization registry. No adverse effects reported at this time. Physician ARNP notified of incident.

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