VAERS ID: 2331382

AGE: | SEX: U|STATE: FR

Description

SKIN RASH; VOMITING; VACCINATION SITE REACTION; WEAKNESS; FEVER; This spontaneous report received from a physician by a Regulatory Authority (RA, PL-URPL-3-14778-2021) on 22-JUN-2022 and concerned a 37 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: 21C19-05 expiry: 27-SEP-2021) 0.5 ml, 01 total (first dose), administered on 09-JUL-2021 at 18:00 for covid-19 immunisation. No concomitant medications were reported. On 10-JUL-2021 at 08:00, the patient experienced rash limited to specific skin areas-forearms and lower leg (skin rash), vomiting, increased reaction at the injection site (vaccination site reaction), significant weakness (weakness), and fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the skin rash, vomiting, vaccination site reaction, weakness and fever was not reported. This report was serious (Other Medically Important Condition).

Symptoms

Asthenia, Pyrexia, Rash, Vaccination site reaction, Vomiting

Vaccines

VAX DATE: 07-09-2021| ONSET DATE: 07-10-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (JANSSEN)) 1 COVID19 JANSSEN 21C19-05 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:PLJNJFOC20220644470
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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