VAERS ID: 1669812

AGE: 41| SEX: F|STATE: FR (Unknown)

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

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Symptoms

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

Vaccines

VAX DATE: | ONSET DATE: 08-06-2021| DAYS TO ONSET:
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 0 COVID19 JANSSEN 212C21A Unknown Unknown

RECVDATE:09-03-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:Comments: Unknown
PRIOR_VAX:
SPLTTYPE:PHJNJFOC20210903812
FORM_VERS:
TODAYS_DATE:09-03-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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