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||301458A / 1||LA / IM|
Administered by: Pharmacy Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age, Wrong product administered
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: None on record
Current Illness: None at time of vaccination
Preexisting Conditions: None on record.
Allergies: None on record
Diagnostic Lab Data: N/A
CDC 'Split Type':
Write-up: Patient came in for a routine flu shot, and was inadvertently given the Pfizer COVID-19 vaccine. Patient is not old enough under current authorizations to receive this vaccine, but patient reported absolutely no adverse reactions. We are filling this form out in an abundance of caution and guidance from our superiors.
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