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

This is VAERS ID 1438943



Case Details

VAERS ID: 1438943 (history)  
Form: Version 2.0  
Age: 14.0  
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 preparation 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 at this time
CDC Split Type:

Write-up: No symptoms no adverse effects. Incorrect reconstitution of complete vial. Diluent applied to vial 0.8 of saline instead of recommended 1.8ml as directed Patient received correct dose of 0.3ml Parent instructed to contact clinic if symptoms arise and to go to ER if life threatening symptoms occur.


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