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

This is VAERS ID 1438804



Case Details

VAERS ID: 1438804 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
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 E38733 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product reconstitution quality issue
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none applicable at this time
CDC Split Type:

Write-up: Incorrect reconstitution of vial. 0.8 mg of saline diluent to complete vial instead of 1.8 as directed. No symptoms, no adverse effects Patient received correct 0.3ml dose concentration of vaccine in dose is higher due to incorrect reconstitution. Parent notified and informed to contact the clinic directly if any symptoms occur. Also informed to go to ER if life threatening symptoms occur. None have occurred at this time.


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