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|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
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
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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