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VAERS ID: 1787264

AGE: 36| SEX: F|State: FR

Description

Chills; This spontaneous report received from a health care professional via Regulatory Authority (RO-NMA-2021-SPCOV12776) on 12-OCT-2021 and concerned a 36 year old female of unspecified race and ethnic origin. The patient's weight was 60 kilograms, and height was 152 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) 1 dosage forms, frequency 1 total administered on 30-SEP-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 30-SEP-2021, the patient experienced chills. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chills. This report was serious (Life Threatening).

Symptoms

Chills

Vaccines

VAX DATE: | ONSET DATE: 30 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:
        N
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        ROJNJFOC20211021830
        FORM_VERS:
        2
        TODAYS_DATE:
        13 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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