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VAERS Report 2115866

Case Report Section

Détails du rapport Vaer

Âge: N/A

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (JANSSEN))

Type : Coronavirus 2019 vaccine

Fabricant: JANSSEN

Lot: unknown


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-05-19
Date d’apparition
170
Nombre de jours (date d’apparition – date de vaccination)
170
Description de l’événement indésirable

vaccination failure; sars-cov-2 infection; this spontaneous report received from a physician by a regulatory authority (ra, at-basgages-2022-002925) on 14-feb-2022 concerned a 51 year old male of unspecified race and ethnicity. 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 was not reported) dose was not reported, 1 total administered on 19-may-2021 for an unspecified indication. the batch number was not reported. per procedure, no follow-up will be requested for this case. no concomitant medications were reported. on 05-nov-2021, the patient experienced vaccination failure, and sars-cov-2 infection (severe acute respiratory syndrome coronavirus 2). laboratory data included: covid-19 pcr (polymerase chain reaction) test (nr: not provided) positive. the action taken with covid-19 vaccine ad26.cov2.s was not applicable. the outcome of the vaccination failure and sars-cov-2 infection was not reported. this report was serious (other medically important condition). this case was associated with product quality complaint, and reference number requested

Données de laboratoire
test date: 20211105; 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