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This is VAERS ID 1555771

History of Changes from the VAERS Wayback Machine

First Appeared on 8/20/2021

VAERS ID: 1555771
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Vaccination failure, Suspected COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-01
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210815127

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19; This spontaneous report received from a company representative on behalf of a health care professional concerned a male patient of unspecified age, 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, route of admin not reported, batch number: Unknown, expiry: unknown) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date after vaccination, the patient experienced suspected covid-19 (suspected clinical vaccination failure). On an unspecified date in AUG-2021 (same week of this report), the patient was hospitalized and was intubated. The duration of hospitalization was not specified. On an unspecified date in AUG-2021 (same week of this report), the patient died of covid-19. 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 suspected clinical vaccination failure and suspected covid-19 on AUG-2021. This report was serious (Death, and Hospitalization Caused / Prolonged). This case was associated with the Product Quality Complaint number 90000188817.; Sender''s Comments: V0: 20210815127- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Suspected COVID-19. 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). 20210815127- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.; Reported Cause(s) of Death: COVID-19

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