1788464

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No adverse event, Product administered to patient of inappropriate age
VAERS_ID:
1788464
CATEGORY:
2021
RECVDATE:
14 October 2021
STATE:
PA
AGE_YRS:
16.00
CAGE_YR:
16
CAGE_MO:
SEX:
F
RPT_DATE:
SYMPTOM_TEXT:
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.
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
Y
VAX_DATE:
25 September 2021
ONSET_DATE:
25 September 2021
NUMDAYS:
0
LAB_DATA:
V_ADMINBY:
PVT
V_FUNDBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
14 October 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
VAX_TYPE:
COVID19
VAX_MANU:
JANSSEN
VAX_LOT:
212A21A
VAX_DOSE_SERIES:
1
VAX_ROUTE:
IM
VAX_SITE:
RA
VAX_NAME:
COVID19 (COVID19 (JANSSEN))