Détails du rapport Vaer
Âge: N/A
Genre: Female
Région : Outside US
- Patient décédé?
- Oui
- 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
- 2021-07-26
- Date d’apparition
- 7
- Nombre de jours (date d’apparition – date de vaccination)
- 7
- Description de l’événement indésirable
-
diffuse pain; this spontaneous report received from a consumer by a regulatory authority (it-minisal02-847097) on 01-mar-2022 and concerned a 79 year old female of unknown race and ethnic origin. the patient's weight was 55 kilograms, and height was 160 centimeters. no past medical history or concurrent conditions were reported. the patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported, expiry: unknown) 1 dosage forms, 1 total, administered on 26-jul-2021 for covid-19 immunisation. the batch number was not reported. the company is unable to perform follow-up request batch/lot numbers. no concomitant medications were reported. on 02-aug-2021, the patient experienced diffuse pain. on an unspecified date, the patient died due to unknown cause. it was unknown if autopsy was performed or not. the action taken with covid-19 vaccine ad26.cov2.s was not applicable. this report was serious (death).; reported cause(s) of death: unknown cause of death
- Données de laboratoire
-
na
- Liste des symptômes
-
pain
- Patient décédé?
- Oui
- 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
-
na