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VAERS ID: 1788464

AGE: 16| SEX: F|State: PA

Description

Patient received Janssen COVID vaccine. After vaccine was administered it was identified that patient was 16 years old and did not meet EUA age requirements. No adverse reactions were noted.

Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 25 September 2021 | ONSET DATE: 25 September 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))
  • 1
  • IM
  • RA
  • 212A21A

RECVDATE:14 October 2021
CAGE_YR:16
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:Y
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:14 October 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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