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VAERS ID: 1787243

AGE: UNK| SEX: M|State: FR

Description

VACCINATION FAILURE; This solicited report received from a health care professional (PT-INFARMED-M202108-3714) on 30-SEP-2021 and concerned a 42-year-old male of an unspecified race and ethnic origin. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient initiated treatment with Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C18-05, and expiry: unknown) 0.5 ml, 1 total was administered on 14-JUL-2021 for covid-19 immunization. No concomitant medications were reported. On 24-JUL-2021, the patient had vaccination failure. The patient diagnostic data was not available. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from vaccination failure on 04-AUG-2021. The reporter provided no causality assessment. Company causality between Covid-19 vaccine ad26.cov2.s, and vaccination failure was not related. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000192362. The suspected product quality complaint has been confirmed to be voided (did not meet product quality complaint criteria) based on the product quality complaint evaluation/investigation performed. This case, involving the same patient is linked to 20210908642. Following receipt of additional information on (30-SEP-2021). It was determined that nullification and deletion was required for Manufacturer Report Number (20210908642) as it was duplicate of Manufacturer Case Number (20211020509). All relevant information regarding Manufacturer Report Number (20210908642) will be submitted under Manufacturer Case Number (20211020509).

Symptoms

Vaccination failure

Vaccines

VAX DATE: | ONSET DATE: 24 July 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:
        Y
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        PTJNJFOC20211020509
        FORM_VERS:
        2
        TODAYS_DATE:
        12 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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