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VAERS Report 2157113

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
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2021-10-30
Date d’apparition
74
Nombre de jours (date d’apparition – date de vaccination)
74
Description de l’événement indésirable

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

Données de laboratoire
test date: 20220113; test name: covid-19 antigen test; result unstructured data: positive
Liste des symptômes
malaise cough pyrexia oropharyngeal pain 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
erythrocytosis (eritrocytosis); gastrooesophageal reflux disease (gerb); steatosis hepatic (steatosis hepatis)