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VAERS ID: 1787219

AGE: UNK| SEX: M|State: FR

Description

VACCINATION FAILURE; This spontaneous report received from a consumer via a Regulatory Authority (regulatory authority, PT-INFARMED-T202109-2203) on 12-OCT-2021 and concerned a 45 year old male. The patient's weight was 110 kilograms, and height was 195 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) 0.5 ml,1 total administered on 03-JUL-2021 for covid-19 immunisation. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 11-SEP-2021, the patient experienced vaccination failure. Laboratory data included: SARS-CoV-2 test (NR: not provided) Positive Iu international unit (s). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from vaccination failure. This report was serious (Other Medically Important Condition). The case is associated with Product quality complaint.

Symptoms

SARS-CoV-2 test, Vaccination failure

Vaccines

VAX DATE: | ONSET DATE: 11 September 2021 | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))

        RECVDATE:
        15 October 2021
        CAGE_YR:
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        Test Date: 20210911; Test Name: SARS-CoV-2 test; Result Unstructured Data: Positive Iu international unit(s)
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        PTJNJFOC20211023594
        FORM_VERS:
        2
        TODAYS_DATE:
        14 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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