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This is VAERS ID 1388334

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1388334
VAERS Form:2
Age:79.0
Sex:Female
Location:North Dakota
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 3 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Extra dose administered, Interchange of vaccine products, Wrong product administered

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: Aspirin 81 mg daily, Atorvastatin 10 mg daily, Cramp tabs 2 daily PRN, losartan 50 mg, omeprazole 20 mg daily
Current Illness: HTN, hyperlipidemia
Preexisting Conditions: See above.
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Phone call from patient''s daughter on 06/07/21 - patient saw doctor last Friday for a complete physical. Order sent to pharmacy for Tdap vaccine. Patient went to pharmacy and received COVID vaccine. Pharmacy staff thought patient requested COVID vaccine. Tdap order was not yet received at pharmacy. Patient had already gotten COVID Pfizer vaccine on 01/28/21 and 02/18/21. Pharmacy states patient did fill out a general consent for vaccine - questions such as do you have a fever or feel ill today? Have you had a reaction to any vaccine before? Consent was not COVID specific. Phone call from Pharmacy staff on 06/07/21 acknowledging wrong vaccine was given.

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