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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1741867

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Case Details

VAERS ID: 1741867 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, 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: Unknown
Current Illness: UnKnown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client 11 year of age receive vaccine recommended for age 12 years and above. Weighted 130 lbs., Monitored for 30 minutes, No signs symptoms of distress. Left from clinic with mother to home at 11:00am


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