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

This is VAERS ID 1470452



Case Details

VAERS ID: 1470452 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

Administered by: Pharmacy       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? Yes
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: Pt had 1st Pfizer dose 4/27/2021 then 2nd Pfizer dose 5/18/2021 at the Pharmacy , then presented to us on 7/3/2021 requesting the J & J immunization. Pt stated NO to receiving any previous Covid-19 vaccines. We were unable to access medical record at that moment so immunized customer believing they had honestly answered the questions pertaining to previous immunizations. Went to add this immunization into the medical record and found the previous immunizations.


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