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VAERS Report 2115865

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Female

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (JANSSEN))

Type : Coronavirus 2019 vaccine

Fabricant: JANSSEN

Lot: xe393


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-07-17
Date d’apparition
110
Nombre de jours (date d’apparition – date de vaccination)
110
Description de l’événement indésirable

sars-cov-2 infection; vaccination failure; this spontaneous report received from a physician by a regulatory authority (ra, at-basgages-2022-002918) on 14-feb-2022 concerned a 31 year old female of unspecified race and ethnic origin. 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, intramuscular, batch number: xe393, expiry: unknown) dose was not reported, dose number in series 1, 01 in total, administered on 17-jul-2021 for unspecified indication. no concomitant medications were reported. on 04-nov-2021, the patient experienced severe acute respiratory syndrome coronavirus 2 (sars-cov-2) infection and had vaccination failure (dose number in series 1). laboratory data included: corona virus disease-19 polymerase chain reaction test (covid-19 pcr test) which showed positive result. the action taken with covid-19 vaccine ad26.cov2.s was not applicable. the outcome of the sars-cov-2 infection and vaccination failure was not reported. this report was serious (other medically important condition). this report is associated with a product quality complaint (pqc) number: 90000217650

Données de laboratoire
test date: 20211104; test name: covid-19 pcr test; result unstructured data: positive
Liste des symptômes
covid-19 sars-cov-2 test vaccination failure
Patient décédé?
Non
Date de décès
N/A
Anomalie congénitale
false
Vaccin administré par :
Other
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na