VAERS ID: 2331151

AGE: | SEX: M|STATE: FR

Description

DEEP VEIN THROMBOSIS LEG; This spontaneous report received from a physician by a Regulatory Authority (RA, FR-AFSSAPS-MA20222477) on 22-JUN-2022 and concerned a 58 year old male of unknown race and ethnic origin. The patient's weight was 95 kilograms, and height was 181 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: XD955 expiry: UNKNOWN) 1 dosage forms, 1 total, administered on 18-MAY-2021 for covid-19 vaccination. Time interval between beginning of drug Administration and start of reaction was 83 days. No concomitant medications were reported. On 09-AUG-2021, the patient experienced deep vein thrombosis leg. Treatment with covid-19 vaccine ad26.cov2.s was withdrawn on 18-MAY-2021. The outcome of deep vein thrombosis leg was not reported. This report was serious (Other Medically Important Condition).

Symptoms

Deep vein thrombosis

Vaccines

VAX DATE: 05-18-2021| ONSET DATE: 08-09-2021| DAYS TO ONSET: 83
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 1 COVID19 JANSSEN XD955 Unknown Unknown

RECVDATE:06-24-2022
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:FRJNJFOC20220645168
FORM_VERS:2
TODAYS_DATE:06-23-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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