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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1371248



Case Details

VAERS ID: 1371248 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 477C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: trazodone, atorvastatin, breo ellipta, tizanidine, duloxetine, gabapentin, meloxicam, wellbutrin, furosemide, finasteride, potassium chloride, folic acid, vitamin d2, norco, ca-d3-mag#11-zinc-cupr-man, proventil hfa
Current Illness: none
Preexisting Conditions: hypertension hyperlipidemia RA
Allergies: PCN, lexapro
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The patient has not experienced an adverse event. This report is being submitted because the patient was given Moderna vaccine for his 2nd dose, but was supposed to receive the Pfizer vaccine.


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