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VAERS Report 2157162

Case Report Section

Vaer Report Details

Age: 34 years old

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
2021-07-27
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

dizziness; difficulty in standing; paresthesia; fatigue; this spontaneous report received from a consumer by a regulatory authority (ie-hpra-2022-092955) on 02-mar-2022 concerned a 34 year old male of unspecified race and ethnicity. the patient's weight was 82.628 kilograms, and height was not reported. the patient's concurrent conditions included: childhood asthma, and other pre-existing medical conditions included: childhood asthma. the patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 0.5 ml, 1 total (first dose) administered on 27-jul-2021 for covid-19 immunization. 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 27-jul-2021, the patient experienced dizziness, difficulty in standing, paresthesia, and fatigue. the action taken with covid-19 vaccine ad26.cov2.s was not applicable. the patient had not recovered from dizziness, difficulty in standing, paresthesia, and fatigue. this report was serious (disability or permanent damage)

Lab Data
na
List of symptoms
paraesthesia fatigue dizziness dysstasia
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?
Yes
Allergies:
na
Current Illness
childhood asthma