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

This is VAERS ID 903007

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Case Details

VAERS ID: 903007 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: 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: Patient had a shingles vaccine 12/10/2020.
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She had received a shingles vaccine on 12/10/2020.


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