From the 3/29/2024 release of VAERS data:

This is VAERS ID 1696757

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Case Details

VAERS ID:	1696757 (history)
Form:	Version 2.0
Age:	11.0
Sex:	Female
Location:	Georgia

Vaccinated:	2021-09-14
Onset:	0000-00-00
Submitted:	0000-00-00
Entered:	2021-09-14

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	FA6780 / 1	LA / IM

Administered by: Private Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was 11 years old and 8 months at the time of vaccine No side effects noted.

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