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

This is VAERS ID 1368222



Case Details

VAERS ID: 1368222 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 2 RA / IM

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

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: 1. Atorvastatin 2. Citalopram 3. Fenofibrate 4. Novolog 5. Omeprazole
Current Illness: n/a
Preexisting Conditions: 1. Type 2 Diabetes 2. Hyperlipidemia 3. Male erectile dysfunction 4. Anxiety 5. Depression 6. Acid Reflux
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in for 2nd dose of Moderna vaccine and received Janssen instead.


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