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

This is VAERS ID 1433230

Case Details

VAERS ID: 1433230 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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: "fluid pill":
Current Illness: n/a
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Mixing/Administration error: Nurse drew up 1.8ml of saline diluent and then drew up 0.3ml of vaccine concentrate from second vial. Injected patient with 2.1 ml of fluid. Did not reconstitute properly.

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