이상반응 보고
| VAERS ID | 2122707 |
|---|---|
| 성별 | 여성 |
| 나이 | 83세 |
| 주 코드 | FR |
| 제약회사 | JANSSEN |
| 로트 번호 | ACB3331 |
| 예방접종 횟수 | 1 |
| 접종일 | 2022-01-18 |
| 발병일 | 2022-02-06 |
| 상태 | 사망 |
증상
- SARS-CoV-2 테스트(SARS-CoV-2 test)
- 코로나 바이러스 감염증 -19 : 코로나 19(COVID-19)
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임상 검사
Test Date: 20220206; Test Name: COVID-19 virus test; Result Unstructured Data: Confirmed covid-19
증상 상세
COVID-19; This spontaneous report received from a health care professional by a Regulatory Authority (PHIFDA, PH-PHFDA-30013571) on 17-FEB-2022 and concerned an 83 year old female of unspecified race and ethnic origin.
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: ACB3331 expiry: unknown) dose was not reported,1 total administered on 18-JAN-2022 for an unspecified indication.
No concomitant medications were reported.
On 06-FEB-2022, the patient experienced covid-19.
Laboratory data included: COVID-19 virus test (NR: not provided) confirmed covid-19.
On 11-FEB-2022, the patient died from covid-19.
It was unknown if an autopsy was performed.
The action taken with covid-19 vaccine ad26.
cov2.
s was not applicable.
The outcome of event covid-19 was fatal.
This report was serious (Death).
; Sender's Comments: V0:20220240268-COVID-19 VACCINE AD26.
COV2.
S- COVID-19.
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).
Therefore, this event(s) is considered unassessable.
; Reported Cause(s) of Death: COVID-19