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This is VAERS ID 1330660

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330660
VAERS Form:2
Age:13.0
Sex:Male
Location:Nevada
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is 13yoa and was administered the Janssen vaccine instead of Pfizer. Reporting due to patient age. Per mom no adverse effects have been experienced at this time.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330660&WAYBACKHISTORY=ON


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