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

This is VAERS ID 1371452



Case Details

VAERS ID: 1371452 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was seen at plant for 2nd Covid 19 vaccine with other employees. He had card with Pfzier identified as first Covid vaccine given. He was in line to receive Moderna 2nd vaccine per scheduled vaccines with plant. Advised partifipants they were getting 2nd Moderna and discussed my personal side effects as well as effectiveness of Moderna. After vaccine given one of coworkers noted half of employees, 5 people including patient was there for 2nd Pzier vaccine. Pt was advised of error and discussed potential side effects. He was monitored for 30 minutes with no adverse effects. Hours later contacted employer and pt remained asymtomatic. He is scheduled for recheck exam. Pt did not have an adverse reaction.


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