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VAERS ID: 1787261

AGE: UNK| SEX: M|State: FR

Description

Hypotension; Chills; Dizziness; Nausea; Headache; Loss of consciousness; Myalgia; This spontaneous report received from a consumer via a Regulatory Authority (RO-NMA-2021-SPCOV12749) was received on 12-OCT-2021 and concerned a 22 year old male of unknown race and ethnicity. The patient's weight was 103 kilograms, and height was 197 centimeters. The patient's past conditions included: sars-cov-2 infection. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XE393 expiry: UNKNOWN) 1 dosage forms, 1 total administered on 22-SEP-2021 for active immunisation. No concomitant medications were reported. On 23-SEP-2021, the patient experienced hypotension, chills, dizziness, nausea, headache, loss of consciousness, and myalgia. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from hypotension, chills, dizziness, nausea, headache, loss of consciousness, and myalgia on 23-SEP-2021. This report was serious (Life Threatening).

Symptoms

Chills, Myalgia, Dizziness, Nausea, Headache, Hypotension, Loss of consciousness

Vaccines

VAX DATE: | ONSET DATE: 23 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:
        Y
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        Medical History/Concurrent Conditions: SARS-CoV-2 infection
        PRIOR_VAX:
        SPLTTYPE:
        ROJNJFOC20211021097
        FORM_VERS:
        2
        TODAYS_DATE:
        12 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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