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

This is VAERS ID 1470301



Case Details

VAERS ID: 1470301 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
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 021B21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products, No adverse event
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: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient presented to clinic 7/12/2021 at 2:00pm for 2nd COVID vaccine. Patient completed the COVID 19 vaccine screening and consent form and said she was here for her 2nd dose. Nurse, RN asked her if her first dose had been Moderna and the patient said yes. Nurse administered the Moderna vaccine and then the client presented the nurse with her vaccine card which listed Pfizer as the first dose Lot #ER2613 administered by mobile vaccination bus on 5/22/2021 . Nurse informed patient of this. Patient had no adverse reactions and left after 15 min monitoring time.


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