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

This is VAERS ID 1330623



Case Details

VAERS ID: 1330623 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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 was given more Pfizer vaccine, intern pulled up 1.8 mls of sodium chloride and then pulled up in same syringe about 0.2 ml from Pfizer vial that was not reconstituted and injected into patient''s arm. The error was realized after the patient had already left. We called patient multiple times and had to leave a message to call us back. We left message with dr office as well and we will keep trying to get a hold of patient. We are not aware of adverse events occurring, but will make patient aware that they are more likely to have flu like symptoms because of the error. I have spoken to my intern and trained even more about the process of giving and have reported error.


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