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

This is VAERS ID 1474685



Case Details

VAERS ID: 1474685 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
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: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer vaccine was given to patient when vaccine was not indicated for the patient. Patient''s mother knowingly gave the nurse the wrong birthdate for the patient.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1474685


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