National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1671102

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 9/10/2021

VAERS ID: 1671102
VAERS Form:2
Age:17.0
Sex:Unknown
Location:Foreign
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted:0000-00-00
Entered:2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Circulatory collapse, Hypotension

Life Threatening? No
Birth Defect? No
Died? No
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': DEJNJFOC20210906366

Write-up: CIRCULATORY COLLAPSE; HYPOTENSION; This spontaneous report received from consumer a via Regulatory Authority (DE-PEI-202100177343) on 01-SEP-2021 and concerned a 17 year old of unspecified sex of unknown 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: XE395 expiry: UNKNOWN) dose was not reported, 1 total administered on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the patient experienced circulatory collapse and hypotension. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the circulatory collapse and hypotension was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: RR: 110/70 HF: 68

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1671102&WAYBACKHISTORY=ON


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