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This is VAERS ID 1766545

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1766545
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Acute respiratory failure, Hypoxia, Motor neurone disease, Respiratory failure

Life Threatening? Yes
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': ITJNJFOC20211008169

Write-up: MOTOR NEURON DISEASE; ACUTE RESPIRATORY INSUFFICIENCY; HYPOXIC; HYPERCAPNIC RESPIRATORY FAILURE; This spontaneous report received from a physician via a Regulatory authority (regulatory authority, IT-MINISAL02-793650) on 05-OCT-2021 and concerned a 62 year old male. 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, intramuscular, batch number: XD975), 0.5 ml, 1 total, administered on 03-JUN-2021 for covid-19 vaccination. No concomitant medications were reported. On 13-SEP-2021, the patient experienced motor neuron disease, acute respiratory insufficiency, hypoxic and hypercapnic respiratory failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from motor neuron disease, acute respiratory insufficiency, hypoxic, and hypercapnic respiratory failure. This report was serious (Life Threatening).

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