National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1759259

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759259
VAERS Form:2
Age:93.0
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: Parkinsons Disease
Allergies: Clindamycin, Hydrocodone, Penicillin
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Covid Clinic scheduled for residents at Home on 10/4/2021. Facility Director of Nursing took Public Health Staff room to room to administer vaccine. Director of Nursing had already completed the needed paper forms prior to clinic. This resident inadvertently received a fourth dose of the pfizer covid 19 vaccine and it was not discovered until entering data into the immunization registry. No adverse effects at this time. Physician notified of the incident.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1759259&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166