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

This is VAERS ID 1442366



Case Details

VAERS ID: 1442366 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
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 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (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: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210667303

Write-up: A DOSE WAS ADMINISTERED FROM THE VIAL WHICH IS OUTSIDE OF ACCEPTABLE REFRIGERATED TIME LIMITS; This spontaneous report received from a pharmacist concerned an adult male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, 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 a dose was administered from the vial which is outside of acceptable refrigerated time limits. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of a dose was administered from the vial which is outside of acceptable refrigerated time limits was not reported. This report was non-serious.


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