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

This is VAERS ID 1785556

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Case Details

VAERS ID: 1785556 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
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: Benztropine 1mg BID, haloperidol decanoate 100mg IM q4weeks, olanzapine 10mg po HS
Current Illness:
Preexisting Conditions: schizophrenia, GERD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient unintentionally received a dose of Moderna Covid vaccine 35 days after, it is believed, completing the Pfizer series in August 2021 (#1- 8/5 or 8/6 #2- 8/26/21) at another facility. Per current medical consultant - patient did not experience any adverse effects associated with the Moderna vaccination.


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