Age: 7.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Adverse reaction, Chest discomfort, Electrocardiogram normal, Headache, Incorrect dose administered
Clinical narrative: 2.4.22 - Patient received wrong dose of Pfizer vaccine at an outside facility (unknown) - was administered the Pfizer adult product and adult COVID vaccine dose.    2.5.22 - Patient's mother called nurse triage line to report adverse effects / side effect (possibly related to dosing error):  Symptoms started last night.   Symptoms include: Constant Moderate Chest Pressure. Received 2nd dose of pfizer vaccine yesterday and developed fever last night 103.9 and chest pressure this morning with headache. Mom received call yesterday that he received the adult dose of pfizer in error.   Patient Has tried Motrin with mild improvement.  2.5.22 - Patient seen in ED:    MEDICAL DECISION MAKING: Supervising Physician:  MD 7-year-old male with cough variant asthma but of otherwise good health presenting to the emergency department for evaluation of chest tightness 1st noted this morning.  Symptoms began following a 2nd dose of COVID-19 vaccination occurring yesterday.  Yesterday he received the adult dose of the Pfizer 19 vaccine and this is also noted in his chart.  Yesterday, patient had a fever of 103.9° F that resolved after doses of home ibuprofen and Tylenol.  Patient noted a chest tightness, worse with exertion today, but otherwise without pleuritic pain, sharp pain, radiating pain, back pain, nausea vomiting, return if fever, or other new symptoms.  No wheezing or dyspnea was noted with these symptoms.  Patient has been nauseous since yesterday this is not acutely worsening.  Patient is not vomiting, notes no abdominal pain, stool changes, or other symptoms.  Patient is seen and evaluated.  Vital signs are reassuring.  Examination is unrevealing.  Patient is a well-appearing child in no acute distress, but otherwise no findings indicative of process that is causing symptoms.  Patient has no significant family medical history. EKG is obtained that is reassuring and otherwise demonstrates no evidence of myocardial injury.  Given presenting symptoms, COVID-19 testing is obtained.  Review of Pfizer FDA EUA shows that the administering provider is responsible for reporting of administration errors, and VAERS reporting if an adverse event occurs is required.  Casse resulting in multisystem inflammatory syndrome and COVID-19 infections resulting in hospitalization and death are to be reported.  Patient is demonstrating no symptoms of MIS, and symptoms and presentation are mild at this time. COVID-19 testing is normal.  On re-evaluation, patient is now stating that his symptoms are consistent with his previously experience symptoms with asthma.  Given proximity of fever to his vaccination, post vaccination fever suspected.  Supportive care is recommended for home therapies.  As he is not presenting with symptoms and findings consistent with acute asthma exacerbation requiring systemic steroids or further treatments, continued prescribed medications are recommended along with follow-up with PCP to optimize treatment.  Patient is discharged home in stable condition.  2.7.22:  Patient seen in another ED - for post-vaccination fevers.  Pt comes in after calling the Drs office today stating child has had fevers form the Covid vaccine on Friday. Mom states the last does of tylenol given to child was this early am. No motrin given since the weekend. Child denies nausea or vomiting. Tolerating fluids, mouth is moist. Well appearing child playing games on phone.