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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1367826



Case Details

VAERS ID: 1367826 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered
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 an undiluted COVID-19 vaccine (Pfizer). Medication was given with no diluent to dilute the vaccine vial and 0.3 mL of the vial contents were administered to the patient.


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