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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1757173

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Case Details

VAERS ID: 1757173 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client recieved Pfizer Dose 1 on 09/12/2021 returned to site to recieve Pfizer Dose 2 on 10/03/2021. Immunization Record shows Janssen given on 03/29/2021. Client reports no severe adverse reaction to Pfizer Dose 1.


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