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

This is VAERS ID 902798



Case Details

VAERS ID: 902798 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ 1685 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Contraindicated product 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient marked that he had received the flu vaccine 7 days ago. This was missed on screening procedure and patient received the vaccine today. Contacted the CDC and instructed to enter a VAERS report.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=902798


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