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

This is VAERS ID 1467754



Case Details

VAERS ID: 1467754 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose 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: n/a
Current Illness:
Preexisting Conditions:
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in and asked to get covid vaccine. He said he hasn''t received it and also checked "not received" on consent form. Later on same day, his daughter called and told us Pt received both Pfizer vaccine at different location on Feb 2021. She said his father just don''t remember that he received already. She understands that he received 3rd dose of Pfizer and let us know if there is any other concern.


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