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

This is VAERS ID 1470127



Case Details

VAERS ID: 1470127 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose 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:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is currently in the nursing home for rehabilitation. Patient was mistakenly given a 3rd dose of the Covid-19 Moderna vaccine. Patient received a Covid-19 Moderna vaccine on 1/18/21, 2/18/21, and 7/13/21.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1470127


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