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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1431518



Case Details

VAERS ID: 1431518 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Syringe issue
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Syringe had a crack in it where it connected to the needle and the vaccine leaked out onto patient''s arm instead of being administer. Patient was then given another dose because the patient received very little if anything at all of the initial dose


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1431518


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