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This is VAERS ID 1418325

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First Appeared on 6/25/2021

VAERS ID: 1418325
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic hepatitis (Chronic liver disease.)
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': ESJNJFOC20210635055

Write-up: CARDIO-RESPIRATORY ARREST; SUDDEN DEATH; This spontaneous report received from a physician via a Regulatory Authority [ES-AEMPS-899114] concerned a 59 year old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s concurrent conditions included chronic hepatitis (chronic liver disease). The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 21C14-04 expiry: unknown) dose was not reported, 1 total administered to arm on 07-JUN-2021 for covid-19 vaccination. No concomitant medications were reported. On 07-JUN-2021, the patient experienced cardio-respiratory arrest and sudden death (dizziness). The cause of death was cardio-respiratory arrest. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of cardio-respiratory arrest on 07-JUN-2021. This report was serious (Death).; Sender''s Comments: V0: 20210635055-Covid-19 vaccine ad26.cov2.s-Cardio-respiratory arrest and Sudden death . 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: CARDIO-RESPIRATORY ARREST

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