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

This is VAERS ID 1783138

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Case Details

VAERS ID: 1783138 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Private       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: overweight myopia OU w/astigmatism
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: there was no adverse reaction. Patient was erroneously given a second Pfizer dose when they were of ineligible age (11 years). Also got the first dose in error here.


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