Adverse Event Reporting
| VAERS ID | 1760669 |
|---|---|
| Gender | Male |
| Age | 60 |
| StateCode | IL |
| Pharmaceutical Company | JANSSEN |
| Lot Number | 1822809 |
| Number of vaccinations | 1 |
| Vaccinated | 2021-10-04 |
| Onset | 2021-10-04 |
| Condition | Died |
Symptoms
- Pain in extremity
- Thrombosis
- Death
Current Illness
unknown
Preexisting Conditions
none reported
Other Medications
unknown
Previous Vaccinations
Allergies
none
Laboratory Data
unknown
Write-up
Per niece a couple hours after getting the vaccine started to have issues with arm and his wife took him to the hospital to get checked out.
It was took late by the time getting to the hospital and patient passed away around 1 pm.
Per the coroner the preliminary cause of death is a blood clot.
This information was provided to the pharmacy by the patients niece around 3 pm.