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From the 1/7/2022 release of VAERS data:

This is VAERS ID 926888

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Case Details

VAERS ID: 926888 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event, Product administered to patient of inappropriate age
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 is 17 years old, and signed up for vaccination with Pfizer vaccine, however decided to attend an earlier clinic with his Mother. At the earlier clinic, only the Moderna vaccine was available, and the vaccinator did not realize his age, and administered Moderna vaccine. It was not realized until after vaccination that he was due to receive the other vaccine because of his age. Patient attended the vaccine clinic with his Mother both were aware of the mistake. Patient had no ill effects after receiving the vaccination.


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