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This is VAERS ID 1776845

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1776845
VAERS Form:2
Age:10.0
Sex:Male
Location:Virginia
Vaccinated:2021-10-01
Onset:2021-10-01
Submitted:0000-00-00
Entered:2021-10-11
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
Died? No
Permanent Disability? No
Recovered? Yes
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: 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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