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

This is VAERS ID 1474509



Case Details

VAERS ID: 1474509 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH T026167 / 1 LA / IM

Administered by: Private       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: none
Current Illness: none
Preexisting Conditions: asthma, HTN, urinary incomitance
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was here for 2 nd Covid Vaccine. She did not bring her vaccine card with her but she stated she got Pfizer vaccine. She also completed Consent Form and marked "Pfizer" vaccine to be administrated. Therefore, she received a Pfizer vaccine today. However, we found out that she received Moderna as a 1st dose 4 weeks ago. I reported and spoke with State Covid hot line and CDC hot line representative. I was told she is considered as fully vaccinated and no further vaccine needed at this time. Patient was informed about this event and verbalized understating. Patient was monitored for another 20 mins at clinic and there was no adverse reaction.


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