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This is VAERS ID 1374204

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1374204
VAERS Form:2
Age:
Sex:Unknown
Location:Illinois
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Product temperature excursion issue

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': USJNJFOC20210605045

Write-up: ADMINISTRATION ERROR; This spontaneous report received from a health care professional concerned patients of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patients received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1808980 and expiry: 20-JUN-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subjects experienced administration error. The action taken with covid-19 vaccine was not applicable. The outcome of administration error was not reported. This report was non-serious. This case, from the same reporter is linked.

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