VAERS ID: 1474162

AGE: 15| SEX: F|STATE: MI (United States)

Description

Pt. is 15yr 10 months old and received the Janssen vaccine instead of Pfizer. Spoke with her and her father, kept in observation for 45 min. Discussed possible side effects and gave printed information, phone numbers to contact if needed.

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Symptoms

Interchange of vaccine products

Vaccines

VAX DATE: 07-14-2021| ONSET DATE: 07-14-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 0 COVID19 JANSSEN 2042A21A IM LA

RECVDATE:07-15-2021
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:NA
V_ADMINBY:PUB
OTHER_MEDS:na
CUR_ILL:na
HISTORY:na
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:07-15-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:na
V_FUNDBY:

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