National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 902987

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 12/18/2020

VAERS ID: 902987
VAERS Form:2
Age:44.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pain, Pain in extremity, Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None requested. APRN followed up with patient 12/17/2020 11:0 0AM EST. The patient only has arm pain, no other side effects noted. The patient has been taking ibuprofen for injection site pain.
CDC 'Split Type':

Write-up: Medication error - reached the patient no harm, additional monitoring to preclude harm. A nurse (RN) diluted new vial of vaccine at 10:41 am. In the midst of adding diluent to vaccine vial, a patient arrived at our vaccine station. After drawing up and administering the 0.3 ml vaccine the RN looked at the vial again and noted that it was almost empty. She became concerned because she had just mixed a new vial and the amount of fluid remaining was not at the expected level. We immediately stopped and reported this to an employee who contacted pharmacy. We notified the patient that there was a discrepancy and had him wait for $g 30 minutes to watch for any reaction. (APRN) called him at 1:30p to check on him and apprise him of the possibility of receiving higher than recommended concentration of vaccine. He stated he felt fine and felt no unusual symptoms.


Changed on 12/24/2020

VAERS ID: 902987 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pain, Pain in extremity, Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None requested. APRN followed up with patient 12/17/2020 11:0 0AM EST. The patient only has arm pain, no other side effects noted. The patient has been taking ibuprofen for injection site pain.
CDC 'Split Type':

Write-up: Medication error - reached the patient no harm, additional monitoring to preclude harm. A nurse (RN) diluted new vial of vaccine at 10:41 am. In the midst of adding diluent to vaccine vial, a patient arrived at our vaccine station. After drawing up and administering the 0.3 ml vaccine the RN looked at the vial again and noted that it was almost empty. She became concerned because she had just mixed a new vial and the amount of fluid remaining was not at the expected level. We immediately stopped and reported this to an employee who contacted pharmacy. We notified the patient that there was a discrepancy and had him wait for $g 30 minutes to watch for any reaction. (APRN) called him at 1:30p to check on him and apprise him of the possibility of receiving higher than recommended concentration of vaccine. He stated he felt fine and felt no unusual symptoms.


Changed on 12/30/2020

VAERS ID: 902987 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pain, Pain in extremity, Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None requested. APRN followed up with patient 12/17/2020 11:0 0AM EST. The patient only has arm pain, no other side effects noted. The patient has been taking ibuprofen for injection site pain.
CDC 'Split Type':

Write-up: Medication error - reached the patient no harm, additional monitoring to preclude harm. A nurse (RN) diluted new vial of vaccine at 10:41 am. In the midst of adding diluent to vaccine vial, a patient arrived at our vaccine station. After drawing up and administering the 0.3 ml vaccine the RN looked at the vial again and noted that it was almost empty. She became concerned because she had just mixed a new vial and the amount of fluid remaining was not at the expected level. We immediately stopped and reported this to an employee who contacted pharmacy. We notified the patient that there was a discrepancy and had him wait for $g 30 minutes to watch for any reaction. (APRN) called him at 1:30p to check on him and apprise him of the possibility of receiving higher than recommended concentration of vaccine. He stated he felt fine and felt no unusual symptoms.


Changed on 5/7/2021

VAERS ID: 902987 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pain, Pain in extremity, Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None requested. APRN followed up with patient 12/17/2020 11:0 0AM EST. The patient only has arm pain, no other side effects noted. The patient has been taking ibuprofen for injection site pain.
CDC 'Split Type':

Write-up: Medication error - reached the patient no harm, additional monitoring to preclude harm. A nurse (RN) diluted new vial of vaccine at 10:41 am. In the midst of adding diluent to vaccine vial, a patient arrived at our vaccine station. After drawing up and administering the 0.3 ml vaccine the RN looked at the vial again and noted that it was almost empty. She became concerned because she had just mixed a new vial and the amount of fluid remaining was not at the expected level. We immediately stopped and reported this to an employee who contacted pharmacy. We notified the patient that there was a discrepancy and had him wait for $g 30 minutes to watch for any reaction. (APRN) called him at 1:30p to check on him and apprise him of the possibility of receiving higher than recommended concentration of vaccine. He stated he felt fine and felt no unusual symptoms.


Changed on 5/21/2021

VAERS ID: 902987 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Kentucky
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Injection site pain, Pain in extremity, Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None requested. APRN followed up with patient 12/17/2020 11:0 0AM EST. The patient only has arm pain, no other side effects noted. The patient has been taking ibuprofen for injection site pain.
CDC 'Split Type':

Write-up: Medication error - reached the patient no harm, additional monitoring to preclude harm. A nurse (RN) diluted new vial of vaccine at 10:41 am. In the midst of adding diluent to vaccine vial, a patient arrived at our vaccine station. After drawing up and administering the 0.3 ml vaccine the RN looked at the vial again and noted that it was almost empty. She became concerned because she had just mixed a new vial and the amount of fluid remaining was not at the expected level. We immediately stopped and reported this to an employee who contacted pharmacy. We notified the patient that there was a discrepancy and had him wait for $g 30 minutes to watch for any reaction. (APRN) called him at 1:30p to check on him and apprise him of the possibility of receiving higher than recommended concentration of vaccine. He stated he felt fine and felt no unusual symptoms.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=902987&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166