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This is VAERS ID 1783185

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1783185
VAERS Form:2
Age:14.0
Sex:Male
Location:California
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Nasal congestion, Immunodeficiency, Product administered to patient of inappropriate age

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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is 14 YO male, arrived to clinic with mother for third dose Pfizer on 10/09/2021 at 11:00 am. Patient''s second dose Pfizer was not reviewed and verified by staff. Patient was administered the Pfizer third dose today. Per staff, patient and mother left Clinic with no adverse events. Writer reviewed patient''s prevaccination Checklist for COVID-19 Vaccines and noticed that patient''s age group is not eligible for the booster COVID-19 vaccine at this time. Mother contacted and confirmed that patient''s second dose was administered on 06/12/2021. Mother stated that patient is not experiences any adverse events at this time; however, it appears that patient may be catching a cold. Patient was scheduled with a HCP at a local HCF for a post vaccination follow up to address any concerns and questions. Per patient''s visit with HCP, mother stated that patient is having nasal congestion. Writer follow up today and mother stated that patient is doing better and that nasal congestion has improved. Mother instructed to monitor symptoms and follow-up with PCP as needed.

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