VAERS ID: 2331379

AGE: 31| SEX: U|STATE: FR

Description

FAINTING; HYPOTONIC HYPORESPONSIVE EPISODE; This spontaneous report received from a physician by a Regulatory Authority (RA, PL-URPL-3-14007-2021) on 22-JUN-2022 and concerned a 31 year old of unspecified sex, race and ethnicity. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C16-04 expiry: 31-MAR-2023) 0.5 ml, 01 total (dose 1), administered on 25-JUN-2021 at 12:38 for covid-19 immunisation. Age at time of vaccination 31 years old. No concomitant medications were reported. On 25-JUN-2021, at 12:50 the patient experienced fainting, and hypotonic hyporesponsive episode. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fainting and hypotonic hyporesponsive episode was not reported. This report was serious (Other Medically Important Condition).

Symptoms

Hypotonic-hyporesponsive episode, Syncope

Vaccines

VAX DATE: 06-25-2021| ONSET DATE: 06-25-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 1 COVID19 JANSSEN 21C16-04 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:PLJNJFOC20220644738
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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