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This is VAERS ID 1442357

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1442357
VAERS Form:2
Age:
Sex:Unknown
Location:Colorado
Vaccinated:0000-00-00
Onset:2021-06-29
Submitted:0000-00-00
Entered:2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Incorrect dose administered, Product administration error

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': USJNJFOC20210666861

Write-up: ADMINISTRATION ERROR / DEVIATION; INAPPROPRIATE DOSE OF VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: 07-AUG-2021) dose was not reported, administered on 29-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-JUN-2021, the subject experienced administration error / deviation. On 29-JUN-2021, the subject experienced inappropriate dose of vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administration error / deviation and inappropriate dose of vaccine administered was not reported. This report was non-serious.

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