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VAERS Report 2095627

Case Report Section

Vaer Report Details

Age: 12 years old

Gender: Male

State: Unknown

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (PFIZER-BIONTECH))

Type: Coronavirus 2019 vaccine

Manufacturer: PFIZER

Lot: fl0007


Date report was received
2022-02-08
Date form completed
Date Vaccinated
2022-02-07
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

patient presented to pediatric vaccination clinic with sibling and mother. patient was given pediatric dose versus adult dose for 2nd shot in series

Lab Data
na
List of symptoms
incorrect dose administered
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na