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This is VAERS ID 1504860

History of Changes from the VAERS Wayback Machine

First Appeared on 7/30/2021

VAERS ID: 1504860
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, SARS-CoV-2 test, Suspected COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: over 80 years old patients had underlying health issues.
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC 'Split Type': USJNJFOC20210741034

Write-up: DEATH; SUSPECTED COVID 19 INFECTION; This spontaneous report received from a company representative via Manufacturer on 16-JUL-2021 concerned multiple patients. Initial information was processed along with the additional information received on 21-JUL-2021. The patient''s height, and weight were not reported. Two patient''s over 80 years old had underlying health issues, and pre-existing medical conditions of other 8 patient''s were not reported. The patient''s received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose, 1 in total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, two patient''s over 80 years old died from an unknown cause after being hospitalized, and eight patients also required hospitalization (hospitalization date unspecified). All patient''s had contracted the virus more than two weeks after being fully vaccinated. The cases are confirmed with a positive test COVID-19 (coronavirus disease) (confirmatory test was not reported) (suspected covid 19 infection). Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of suspected covid 19 infection was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged). This report was associated with product quality complaint, 90000186727.; Sender''s Comments: V0 20210741034-COVID-19 VACCINE AD26.COV2.S-Death and suspected covid 19 infection. This event(s) is considered unassessable. The event(s) has an unknown/unclear 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: UNKNOWN CAUSE OF DEATH

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