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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 902798 |
VAERS Form: | 2 |
Age: | 72.0 |
Sex: | Male |
Location: | North Carolina |
Vaccinated: | 2020-12-16 |
Onset: | 2020-12-16 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-16 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EJ 1685 / 1 | RA / IM |
Administered by: Other Purchased by: ??
Symptoms: Circumstance or information capable of leading to medication error, Contraindicated product administered
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
CDC 'Split Type':
Write-up: Patient marked that he had received the flu vaccine 7 days ago. This was missed on screening procedure and patient received the vaccine today. Contacted the CDC and instructed to enter a VAERS report.
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