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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1367708



Case Details

VAERS ID: 1367708 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-02
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: none to report
Allergies: allergic to versed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pharmacist had many things going on and went to give shot, and afterwards realized the patient was 17 at time of vaccination. The patient and mother both requested Janssen. The typing technician didn''t realize the age. Patient has had no adverse effects. The patient and state health department have been notified


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367708


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