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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN||- / UNK||- / -|
Administered by: Other Purchased by: ??
Symptoms: Circulatory collapse, Malaise, Pyrexia
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Preexisting Conditions: Medical History/Concurrent Conditions: IDDM; Comments: IDDM
Diagnostic Lab Data:
CDC 'Split Type': ATJNJFOC20210655539
Write-up: UNOBSERVED CIRCULATORY ARREST, DEATH; SUBFEBRILE; FEELING SICK / FEELING UNWELL; This spontaneous report received from a physician via a Regulatory Authority (EMEA EVHUMAN NLP, AT-BASGAGES-2021-32463) concerned a 65 year old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s past medical history included IDDM (Type 1 diabetes mellitus), and other pre-existing medical conditions included IDDM. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD986, expiry: unknown) 1 dosage forms, frequency 1 total dose administered on 10-JUN-2021 for covid-19 immunisation. No concomitant medications were reported. On 10-JUN-2021, the patient was subfebrile, feeling sick/feeling unwell. On 16-JUN-2021, the patient experienced unobserved circulatory arrest, and died. An autopsy was not performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unobserved circulatory arrest, subfebrile and feeling sick/feeling unwell on 16-JUN-2021. This report was serious (Death).; Sender''s Comments: V0:20210655539-COVID-19 VACCINE AD26.COV2.S- Unobserved Circulatory arrest death , subfebrile , feeling sick/ feeling unwell . 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: CIRCULATORY FAILURE; SUBFEBRILE; FEELING SICK/FEELING UNWEL
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