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