VAERS ID: 2327618

AGE: 32| SEX: F|STATE: MD

Description

Pt got only 1 dose of Pfizer on 7/19/21 and she came into our pharmacy and request Janssen vaccine to be given to her. Pt didn't want Pfizer any more and the dose was 338 days ago so I gave her a dose of Janssen as per her requested. So far pt had not report any reaction with Janssen ( @7:33pm). I just want to document i had given Janssen.

Symptoms

Interchange of vaccine products

Vaccines

VAX DATE: 06-22-2022| ONSET DATE: 06-22-2022| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 1 COVID19 JANSSEN 1855835 IM LA

RECVDATE:06-22-2022
RPT_DATE:
CAGE_YR:32
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:n/a
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:06-22-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKDA
V_FUNDBY:

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