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VAERS ID: 1787257

AGE: 31| SEX: M|State: FR

Description

Fever; Headache; Breathing difficult; Painful cough; This spontaneous report received from a consumer via Regulatory Authority (RO-NMA-2021-SPCOV12695) on 12-OCT-2021 and concerned a 31 year old male of unspecified race and ethnic origin. The patient's weight was 65 kilograms, and height was 168 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: 21C18-05 expiry: UNKNOWN) 1 dosage forms, frequency 1 total administered on 19-SEP-2021 for covid-19 immunisation. No concomitant medications were reported. On 19-SEP-2021, the patient experienced fever, headache, breathing difficult and painful cough and was hospitalized (date unspecified). Laboratory data included: Body temperature (NR: not provided) 40 Cel. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fever, headache, breathing difficult, and painful cough. This report was serious (Hospitalization Caused / Prolonged).

Symptoms

Body temperature, Cough, Dyspnoea, Headache, Pyrexia

Vaccines

VAX DATE: | ONSET DATE: 19 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:
        Y
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        Test Date: 20210919; Test Name: Body temperature; Result Unstructured Data: 40 C
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        ROJNJFOC20211024551
        FORM_VERS:
        2
        TODAYS_DATE:
        14 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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