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This is VAERS ID 1442366

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1442366
VAERS Form:2
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

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: 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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