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VAERS ID: 1669812

AGE: 41| SEX: F|State: FR

Description

BACK PAIN; BODY MALAISE; COUGH; FEVER; LOSS OF APPETITE; STIFFNESS; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102497] concerned a 41 year old female. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 212C21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-AUG-2021, the patient experienced back pain, body malaise, cough, fever, loss of appetite and stiffness. On an unspecified date, the patient died from back pain, body malaise, cough, fever, loss of appetite, back pain, and stiffness. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender's Comments: V0: 20210903812-covid-19 vaccine ad26.cov2.s-back pain, body malaise, cough, fever, loss of appetite and stiffness. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BODY MALAISE; COUGH; FEVER; LOSS OF APPETITE; BACK PAIN; STIFFNESS

Symptoms

Back pain, Pyrexia, Cough, Decreased appetite, Malaise, Musculoskeletal stiffness

Vaccines

VAX DATE: | ONSET DATE: 06 August 2021 | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))

        RECVDATE:
        03 September 2021
        CAGE_YR:
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        Comments: Unknown
        PRIOR_VAX:
        SPLTTYPE:
        PHJNJFOC20210903812
        FORM_VERS:
        2
        TODAYS_DATE:
        03 September 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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