Adverse Event Reporting

VAERS ID 1818291
Gender Male
Age 41
StateCode NC
Pharmaceutical Company MODERNA
Lot Number 939904
Number of vaccinations 3
Vaccinated 2021-10-25
Onset 2021-10-25
Condition Recovered
  • Extra dose administered
  • No adverse event
  • Wrong product administered

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations


Laboratory Data



Patient had scheduled an appointment and filled out paperwork to receive flu shot.
Was inadvertently given booster dose of Moderna COVID 19 vaccine.
No adverse effects were reported, and patient was informed of error.
Patient had completed doses 1 and 2 of Moderna vaccine 6 months prior, so timing was appropriate.