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

This is VAERS ID 1474759



Case Details

VAERS ID: 1474759 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: D.C.  
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 EW0180 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Moderna Vaccine 04/05/2021, and left the country, he came into the clinic today and asked for a Pfizer Covid-19 vaccine. He stated that since he missed his return date for Moderna of 05/05/2021. He would like to get the Pfizer Covid-19 vaccine. He stated that he had discussed it with his PCP.


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