Vaer Report Details
Age: NA
Gender: Male
State: Outside US
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (JANSSEN))
Type: Coronavirus 2019 vaccine
Manufacturer: JANSSEN
Lot: unknown
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-10-30
- Date of Onset
- 74
- Number of days (onset date – vaccination date)
- 74
- Adverse Event Description
-
vaccination failure; covid-19; dry cough; malaise; pyrexia; sore throat; this spontaneous report received from a physician by a regulatory authority (hr-halmed-300054315) on 28-feb-2022 and concerned a 53 year old male of unspecified race and ethnic origin. the patient's weight was 95 kilograms, and height was not reported. the patient's concurrent conditions included erythrocytosis, steatosis hepatic, and gastroesophageal reflux disease. the patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported, expiry: unknown) 0.5 ml, 1 total (first dose) administered on 30-oct-2021 for covid-19 immunisation. the batch number was not reported. the company is unable to perform follow-up to request batch/lot numbers. no concomitant medications were reported. on 12-jan-2022, the patient experienced malaise, pyrexia, sore throat, and dry cough. on 13-jan-2022, the patient experienced vaccination failure, and covid-19. laboratory data included: covid-19 antigen test (nr: not provided) positive. the action taken with covid-19 vaccine ad26.cov2.s was not applicable. the patient recovered from malaise, pyrexia, sore throat, and dry cough on 21-jan-2022, and vaccination failure, and covid-19. this report was serious (other medically important condition). this report was associated with product quality complaint
- Lab Data
-
test date: 20220113; test name: covid-19 antigen test; result unstructured data: positive
- List of symptoms
-
malaise cough pyrexia oropharyngeal pain covid-19 sars-cov-2 test vaccination failure
- Patient Died?
- No
- Date Died
- NA
- Birth defect
- false
- Vaccine Administered By:
- Other
- Vaccine Purchased By:
- Unknown
- Patient visit ER?
- No
- Patient Hospitalized?
- No
- Stay in hospital
- No
- Days in hospital
- Unspecified
- Permanent disability?
- No
- Allergies:
-
na
- Current Illness
-
erythrocytosis (eritrocytosis); gastrooesophageal reflux disease (gerb); steatosis hepatic (steatosis hepatis)