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VAERS ID: 1376500

AGE: 15| SEX: F|State: FL

Description

Patient vaccinated with Pfizer 3 weeks previously. Inadvertently, today 06/06/21 was administered the Janssen vaccine. Patient was placed under observation for 45min. The patient became very upset, upon being advised the second dose received was not the Pfizer but Janssen. She was see by site medical (Fire Rescue) and the parent declined transport to hospital after contacting the Pediatrician. All vitals signs were within normal limits when patient left the observation area.

Symptoms

Anger, Interchange of vaccine products

Vaccines

VAX DATE: 05 June 2021 | ONSET DATE: 05 June 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))
  • 1
  • IM
  • LA
  • 202A21A

RECVDATE:05 June 2021
CAGE_YR:15
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:U
LAB_DATA:None
V_ADMINBY:OTH
OTHER_MEDS:UKN
CUR_ILL:NONE
HISTORY:NONE
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:05 June 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:NONE
V_FUNDBY:
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