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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1840529

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Case Details

VAERS ID: 1840529 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-03
Onset:2021-11-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered
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: NO Prescription or OTC medications aware of
Current Illness: NO known illnesses
Preexisting Conditions: NO known chronic or long standing health conditions
Allergies: NO known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was given Pfizer Adult. 0.2 ml of the adult formulation.


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