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VAERS ID: 1669805

AGE: UNK| SEX: U|State: FR

Description

DEATH; This spontaneous report received from a consumer via a company representative through social media, concerned a patient of unspecified age, sex, race and ethnicity. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration was not reported, batch number: unknown and expiry date: unknown) dose, start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, following vaccination, the patient died. The cause of death was unknown. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was fatal. This report was serious (Death).; Sender's Comments: V0-20210902668-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH

Symptoms

Death

Vaccines

VAX DATE: | ONSET DATE: | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))

        RECVDATE:
        03 September 2021
        CAGE_YR:
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        Comments: Unknown
        PRIOR_VAX:
        SPLTTYPE:
        PHJNJFOC20210902668
        FORM_VERS:
        2
        TODAYS_DATE:
        03 September 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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