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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1764949

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Case Details

VAERS ID: 1764949 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Public       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: Patient was given 3rd dose of Covid-19 vaccine, had said she had Pfizer with prior 2 doses. After receiving immunization, RN noted on vaccine card that patient had received Moderna vaccine for first 2 doses. RN called Pfizer to advise, was instructed no further action to be taken. Patient has been notified.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1764949


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