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

This is VAERS ID 1371597



Case Details

VAERS ID: 1371597 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
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 EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, 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: unknown.
Current Illness: unknown.
Preexisting Conditions: unknown.
Allergies: none known.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered was diluted w amount of diluent smaller than recommended resulting in a higher concentration of vaccine administered.


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