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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1328552



Case Details

VAERS ID: 1328552 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not actually have any Adverse effects, situation is when we tried to bill the patient''s vaccine, we found she already had a profile in our system for the year of 2009, called the pharmacy that gave her the flu shot in September 2020 and they confirmed that consent form marked year of 2009. I then proceed to call the mother and she confirmed at least twice that the daughter was born in 2008 and that she thinks she wrote the year wrong last year for the flu shot. However, in the evening when we tried to bill the insurance it also stated the year of 2008 was invalid DOB.


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