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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1347370



Case Details

VAERS ID: 1347370 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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: N/A
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Participant received J&J COVID-19 vaccine on 4/11/21 and should not have received Moderna COVID vaccine. participant answered ''no'' to ever receiving a COVID-19 vaccine in the past on the prescreening questionnaire.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1347370


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