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VAERS Report 2157113

Case Report Section

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)