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VAERS Report 2157417

Case Report Section

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