Adverse Event Reporting
| VAERS ID | 1457614 |
|---|---|
| Gender | Male |
| Age | 71 |
| StateCode | OH |
| Pharmaceutical Company | JANSSEN |
| Lot Number | 205A21A |
| Number of vaccinations | 1 |
| Vaccinated | 2021-06-15 |
| Onset | 2021-06-15 |
| Condition | Died |
Symptoms
- Abnormal behaviour
- Death
- Motor dysfunction
- Exophthalmos
Current Illness
N/A
Preexisting Conditions
Vascular dementia with behaviors, coronary artery disease, hyperlipidemia, history of left hip pain, history of bladder stones, heurogenic bladder, history of coronary artery bypass graft x5
Other Medications
Patient wife not good historian. According to other pharmacy where patient filled, he has been on isosorbide, citalopram, quetiapine, risperidone, rosuvastatin, and tamsulosin in past. Patient was nonadherent according to that pharmacist. P
Previous Vaccinations
states flu vaccine gave him the flu (unknown date of specific vaccine)
Allergies
Aricept, oxybutinin, terbinafine
Laboratory Data
Write-up
Patient's wife states that he was not the same the evening after receiving the vaccine.
She stated that he was unable to hold objects and his eyes were bulging from his head.
He was going to a nursing facility after vaccination and later died on 7/4/21.