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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1708829

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Case Details

VAERS ID: 1708829 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-09-16
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Headache, Interchange of vaccine products, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was mistakenly given Moderna Covid Vaccine. It was noticed by staff when patient was called for scheduling of second dose. Mom informed of med error and stated that patient developed the following symptoms after having received the first dose of the vaccine: fever (102 F), chills, headache, cough, runny nose for a couple of days after administration.


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