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This is VAERS ID 1706536

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First Appeared on 9/17/2021

VAERS ID: 1706536
VAERS Form:2
Age:17.0
Sex:Male
Location:New Jersey
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

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': USJNJFOC20210924202

Write-up: ADMINISTERED THE COVID-19 VACCINE TO A 17 YEAR OLD PATIENT; This spontaneous report received from a pharmacist concerned a 17 year old male. 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: 207A21A, expiry: 21-SEP-2021) dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-SEP-2021, the patient experienced administered the covid-19 vaccine to a 17 year old subject. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered the covid-19 vaccine to a 17 year old patient was not reported. This report was non-serious.

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