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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1437966



Case Details

VAERS ID: 1437966 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: Nickel, Latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received one dose of Pfizer after receiving one dose of Janssen in March 2021. The patient intentionally misled the pharmacy to receive this vaccine based on a study the patient read in order to boost his immunity,


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1437966


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