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This is VAERS ID 1760446

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1760446
VAERS Form:2
Age:26.0
Sex:Male
Location:California
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 EW0196 / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Incorrect dose administered, No adverse event, Product preparation error

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: No adverse outcomes have occurred thus far, however, patient was given .3 mL of Pfizer BioNTech vaccine straight (undiluted). The dose was drawn up without being reconstituted and was given to patient. We informed patient and had PCM monitoring x45 minutes. Consulted with Immunologist on next steps. Discussed red flag symptoms such as chest pain, racing heart, severe pain, etc. and when patient should go to the ER. Will follow up with patient in the morning to see how he feels.

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