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

This is VAERS ID 1371465



Case Details

VAERS ID: 1371465 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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: Cardiac Med (Unknown by patient)
Current Illness: Cardiac
Preexisting Conditions: Cardiac
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: This is for documentation only. Patient stated she received her 1st dose of Pfizer on May 13th, 2021. Confirmed by her daughter. However, the state reporting system says she got Johnson and Johnson. Patient received dose of Pfizer today. No apparent adverse reaction at this time. Patient was held for 30 minutes. No problems. Patient did not bring her vaccination card to appointment


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371465


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