VAERS ID: 1577630

AGE: 17| SEX: M|STATE: ME (United States)

Description

Patient received Janssen vaccine at age of 17. The patient did not experience any adverse reactions to the vaccine.

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Symptoms

No adverse event, Product administered to patient of inappropriate age

Vaccines

VAX DATE: 08-06-2021| ONSET DATE: 08-06-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 1 COVID19 JANSSEN 203A21a IM LA

RECVDATE:08-17-2021
RPT_DATE:
CAGE_YR:17
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:08-17-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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