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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1391259



Case Details

VAERS ID: 1391259 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Off label use, Product administered to patient of inappropriate age, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210614070

Write-up: FEVER; INJECTION SITE PAIN IN LEFT ARM; PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE; OFF LABEL USE; This spontaneous report received from a pharmacist concerned an adolescent female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included unknown. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 03-JUN-2021, the subject experienced product administered to subject of inappropriate age. On 03-JUN-2021, the subject experienced off label use. On 05-JUN-2021, the subject experienced fever. On 05-JUN-2021, the subject experienced injection site pain in left arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever, injection site pain in left arm, product administered to patient of inappropriate age and off label use was not reported. This report was non-serious.


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