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

This is VAERS ID 1474480



Case Details

VAERS ID: 1474480 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I gave the patient a Pfizer COVID-19 vaccine after confirming the patient had not received any previous doses of the vaccine verbally and from the consent form. After processing the vaccine, I could see that they had already gotten a Moderna COVID-19 vaccine from another pharmacy on 4/20/21. The patient denies getting the Moderna vaccine.


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