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

This is VAERS ID 1385427



Case Details

VAERS ID: 1385427 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, Product administration error
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: RN TRIED TO VACCINATE AND PUNCTURED PT''S LEFT DELTOID AND PT PULLED AWAY. DOSE WAS NOT ADMINISTERED. BHS WAS CALLED AND PT WAS TAKEN TO PRIVACY AREA. FULL DOSE WAS ADMINISTERED TO RIGHT DELTOID WITHOUT COMPLICATIONS.


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