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

This is VAERS ID 1470436



Case Details

VAERS ID: 1470436 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Incorrect product formulation administered, Nervousness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

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: No Known Health condition
Preexisting Conditions:
Allergies: No Known Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to the pharmacy to get his first dose of Shingrix. This vaccine was processed correctly, however when the immunizing tech saw the VAR form on the counter, she assumed that pt was here for the COVID vaccine and administered Pfizer COVID shot. After pt received his COVID vaccine-card, he realized that he was given incorrect vaccine. Per pt he already completed two doses of Pfizer in the past (04/13/21. 05/04/21). He mentioned he had been fasting from last night for his blood work up this morning. He stated he was feeling little shaky and dizzy. Pt stayed at the waiting area for about 20 mins and he did not complain any further symptoms.


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