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This is VAERS ID 1771904

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1771904
VAERS Form:2
Age:88.0
Sex:Male
Location:Florida
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain in extremity, Product preparation issue

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: UNKNOWN
Allergies: NONE KNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DOSE INJECTED WAS STRONGER THAN 30MCG/0.3ML . THE VIAL OF PFIZER VACCINE WAS DILUTED IMPROPERLY USING ONLY 1.2ML OF SALINE, INSTEAD 1.8ML, SO THE RESULTING SOLUTION WAS MORE CONCENTRATED. THE PATIENT GOT A 0.3ML DOSE, BUT IT CONTAINED ABOUT 30% MORE ANTIGEN (ABOUT 38.5MCG DOSE). PATIENT WAS CONTACTED AND TO DATE HAS HAD NO ADVERSE REACTIONS OTHER THAN A SORE ARM. REPORT OF EVENT WAS ALSO FAXED TO PATIENT''S DOCTOR FOR INCLUSION IN CHART.

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