2VW-17458-20666

1 vaccination 8 coded responses 16 check-ins 8 free-text entries 5 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 334 / FL
Registered: 2021-04-11

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-11
Registered in v-safe
2021-04-11
Dose 1 — Janssen/Johnson & Johnson
2021-04-11
Survey response — day 0, dose 1
MedDRA: Concussion, Immediate post-injection reaction, Loss of consciousness, Nausea, Syncope — Feeling: Poor · Site: Pain · Fatigue or tiredness, Nausea · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Fainting. · Healthcare visit (other): Passed out 4 minutes after shot and hit head. Have mild concussion and continued nausea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Report sent to call center — day 0, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-13
Call 1 — Left Voicemail
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Paraesthesia — Feeling: Poor · Site: Pain · Nausea · Be unable to do your normal daily activities

Free text: Lightheaded, tingling in limbs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Poor · Site: Pain · Headache, Nausea · Be unable to work, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Nausea

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-04-18
Health check-in — day 7, dose 1
Feeling: Poor · Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-04-25
Survey response — day 14, dose 1
MedDRA: Chest discomfort, Chest pain, Headache — Feeling: Good

Free text: Headache and chest pain/tightness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Call 1 — Left Voicemail
2021-05-02
Health check-in — day 21, single dose
Feeling: Fair

Adult check-in
2021-05-11
Survey response — day 28, single dose
MedDRA: Headache — Feeling: Fair

Free text: I am getting more frequent headaches (prior to vaccine, I did not previously get headaches)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Health check-in — day 35, single dose
Feeling: Fair

Adult check-in
2021-05-23
Survey response — day 42, single dose
MedDRA: Headache, Nausea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I continue to have nausea and headaches most days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — day 42, single dose
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-27
Call successful
Participant prefers to complete VAERS report online
2021-07-13
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-10-11
Survey response — 6 months, dose 1
MedDRA: Palpitations — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I have heart palpitations when I exercise which I did not experience before the vaccine

MedDRA releases: 2024-11 · check-in free text available
2021-10-11
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-13
Call 1 — Left Voicemail
2022-04-12
Survey response — 12 months, dose 1
MedDRA: Alopecia, Autoimmune thyroiditis, Electric shock sensation, Heart rate abnormal — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Hashimotos diagnosis Hair loss Sudden Changes in heart rate Intermittent 'electrical' zaps in head

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Report sent to call center — 12 months, dose 1
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-04-13
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-11	Janssen/Johnson & Johnson

Call center

Reported	Outcome	VAERS-related outcome
2021-04-11	Successful	Participant prefers to complete VAERS report online
2021-04-15	Successful	Participant prefers to complete VAERS report online
2021-05-23	Successful 2021-05-27	Participant prefers to complete VAERS report online
2021-10-11	Successful	Does not wish to fill out VAERS report
2022-04-12	Successful 2022-04-13	Does not wish to fill out VAERS report

Free text

Release 7 — day 0, dose 1

2021-04-11

Systemic reaction (other): Fainting.

Healthcare visit (other): Passed out 4 minutes after shot and hit head. Have mild concussion and continued nausea.

Release 7 — days 1–6 daily, dose 1

2021-04-14

Systemic reaction (other): Lightheaded, tingling in limbs

2021-04-15

Systemic reaction (other): Lightheaded

Release 7 — day 14, dose 1

2021-04-25

Symptoms: Headache and chest pain/tightness

Release 8 — day 28, single dose

2021-05-11

Symptoms: I am getting more frequent headaches (prior to vaccine, I did not previously get headaches)

Release 8 — day 42, single dose

2021-05-23

Symptoms: I continue to have nausea and headaches most days.

Release 10 — 6 months, dose 1

2021-10-11

Symptoms: I have heart palpitations when I exercise which I did not experience before the vaccine

Release 11 — 12 months, dose 1

2022-04-12

Symptoms: Hashimotos diagnosis Hair loss Sudden Changes in heart rate Intermittent 'electrical' zaps in head

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
HCVO	Concussion	✓	✓	✓
HCVO	Immediate post-injection reaction	✓	✓	✓
HCVO	Loss of consciousness	✓	✓	✓
HCVO	Nausea	✓	✓	✓
SD	Alopecia	·	·	✓
SD	Autoimmune thyroiditis	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Electric shock sensation	·	·	✓
SD	Headache	✓	✓	✓
SD	Heart rate abnormal	·	·	✓
SD	Nausea	✓	✓	✓
SD	Palpitations	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Syncope	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release