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

This is VAERS ID 1376039



Case Details

VAERS ID: 1376039 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Wrong product administered
SMQs:, Medication errors (narrow)

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: Pt was given Pfizer today and given Moderna on 5/7/21
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given Pfizer vaccine as the second vaccine in the series when pt had Moderna as 1st vaccine in the series. Pt had no adverse reaction to the vaccine today.


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