Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|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
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
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.
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21525 Ridgetop Circle, Suite 100, Sterling, VA 20166