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VAERS ID: 1787260

AGE: 34| SEX: F|State: FR

Description

MYALGIA; CHILLS; STOMACH ACHE; NAUSEA; FEVER; HEADACHE; EYE PAIN; INSOMNIA; ARTHRALGIA; This spontaneous report received from a consumer via a Regulatory authority (RO-NMA-2021-SPCOV12711) on 12-OCT-2021 and concerned a 34 year old female. The patient's weight was 60 kilograms, and height was 168 centimeters. The patient's past medical history included: sars-cov-2 infection. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XE389 expiry: UNKNOWN) 1 dosage forms, 1 total administered on 25-SEP-2021 for active immunisation. No concomitant medications were reported. On 08-DEC-2020, Laboratory data included: SARS-CoV-2 RT-PCR test (NR: not provided) Positive. On 25-SEP-2021, the patient experienced myalgia, chills, stomach ache, nausea, fever, headache, eye pain, insomnia, arthralgia. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the myalgia, chills, stomach ache, nausea, fever, headache, eye pain, insomnia and arthralgia was not reported. This report was serious (Life Threatening).

Symptoms

Abdominal pain upper, Insomnia, Arthralgia, Myalgia, Chills, Nausea, Eye pain, Pyrexia, Headache, SARS-CoV-2 test

Vaccines

VAX DATE: | ONSET DATE: 25 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:
        Y
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        U
        LAB_DATA:
        Test Date: 20201208; Test Name: SARS-CoV-2 RT-PCR test; Result Unstructured Data: Positive
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        Medical History/Concurrent Conditions: SARS-CoV-2 infection
        PRIOR_VAX:
        SPLTTYPE:
        ROJNJFOC20211023637
        FORM_VERS:
        2
        TODAYS_DATE:
        13 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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