National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1434115

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1434115
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:0000-00-00
Onset:2021-06-18
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Cerebral venous sinus thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-18
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEJNJFOC20210660106

Write-up: THROMBOSIS OF VENOUS SINUSES; This spontaneous report received from a physician via a Regulatory Authority DE-PEI-202100110773 concerned a 44 year old female. 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, route of admin not reported, batch number: XB985) dose was not reported, administered on 07-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-JUN-2021, the patient experienced thrombosis of venous sinuses and died. It was unknown if an autopsy was performed. Outcome of the event was fatal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: This spontaneous report received from a physician via Regulatory Authority DE-PEI-202100110773 concerns a 44 year old female who had thrombosis of venous sinuses and died 11 days after receiving the Janssen Covid-19 vaccine. Patient''s height and weight were not reported. Patient''s concurrent conditions and concomitant medications were not reported. Information regarding past smoking history, illicit drug use and alcohol abuse were not provided. Information is limited in this case. The relationship of the thrombosis of the venous sinuses to vaccination is considered unclassifiable due to insufficient information. Additional information has been requested.; Reported Cause(s) of Death: THROMBOSIS OF VENOUS SINUSES

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1434115&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166