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

This is VAERS ID 1440911



Case Details

VAERS ID: 1440911 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-07
Onset:2021-07-01
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had received a J&J vaccine on 3/7/2021. Patient had self scheduled in the vaccine clinic on 7/1/2021.. Patient informed staff this was his first vaccine. Moderna vaccine given to patient. When entering information on system, we noted the Janssen vaccine under patient name with same birth date and same address.


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