3WL-11769-60857

1 vaccination 7 coded responses 13 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 950 / CA
Registered: 2021-05-19

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

2021-05-18
Dose 1 — Janssen/Johnson & Johnson
2021-05-19
Registered in v-safe
2021-05-20
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-21
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Adult check-in
2021-05-21
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-22
Survey response — days 1–6 daily, dose 1
MedDRA: Night sweats — Feeling: Poor · Site: Pain · Abdominal pain · Be unable to do your normal daily activities

Free text: Night sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal pain, Gastritis — Feeling: Fair · Site: Pain · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Diagnosed and treated for gastritis 3 days after vaccination. Related abdominal pain started 12-15hrs post vaccination shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Abdominal pain · Be unable to work

Adult check-in
2021-05-25
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Fair · Fatigue or tiredness, Abdominal pain

Free text: Dizzyness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Survey response — day 14, dose 1
MedDRA: Abdominal pain upper, Dyspepsia, Faeces discoloured, Fatigue, Gastrointestinal disorder, Tooth disorder, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Dental/wisdom teeth issues (never had problems before vaccination, started ~12-24hr post vaccination)Abdominal/digestion issues - yellow stool, stomach aches, heartburnIntermittent fatigue · Healthcare visit (other): Scheduled appointment to follow up with PCP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-08
Survey response — day 21, single dose
MedDRA: Abdominal pain, Faeces discoloured — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Yellow stool, occasional abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Report sent to call center — day 21, single dose
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-08
Call successful
Participant prefers to complete VAERS report online
2021-06-16
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-06-22
Survey response — day 35, single dose
MedDRA: Dizziness — Feeling: Fair

Free text: Dizzyness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-29
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-08-18
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-11-18
Survey response — 6 months, dose 1
MedDRA: Abdominal pain upper, Abdominal tenderness, Abortion of ectopic pregnancy, Cyst removal, Ectopic pregnancy, Faeces discoloured, Ovarian cyst — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: Ectopic pregnancy & surgery to remove pregnancy & large ovarian cyst, reoccurring yellow/clay stool, infrequent upper abdominal pain/tenderness

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — 6 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-19
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-18	Janssen/Johnson & Johnson

Call center

Reported	Outcome	VAERS-related outcome
2021-05-21	Successful	Participant prefers to complete VAERS report online
2021-06-01	Successful 2021-06-08	Participant prefers to complete VAERS report online
2021-06-08	Successful	Participant prefers to complete VAERS report online
2021-11-18	Successful 2021-11-19	Participant prefers to complete VAERS report online

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-22

Systemic reaction (other): Night sweats

2021-05-23

Systemic reaction (other): Diagnosed and treated for gastritis 3 days after vaccination. Related abdominal pain started 12-15hrs post vaccination shot

Release 8 — day 7, dose 1

2021-05-25

Systemic reaction (other): Dizzyness

Release 8 — day 14, dose 1

2021-06-01

Symptoms: Dental/wisdom teeth issues (never had problems before vaccination, started ~12-24hr post vaccination)Abdominal/digestion issues - yellow stool, stomach aches, heartburnIntermittent fatigue

Healthcare visit (other): Scheduled appointment to follow up with PCP

Release 8 — day 21, single dose

2021-06-08

Symptoms: Yellow stool, occasional abdominal pain

Release 9 — day 35, single dose

2021-06-22

Symptoms: Dizzyness

Release 10 — 6 months, dose 1

2021-11-18

Symptoms: Ectopic pregnancy & surgery to remove pregnancy & large ovarian cyst, reoccurring yellow/clay stool, infrequent upper abdominal pain/tenderness

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	Unevaluable event	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Abdominal tenderness	·	·	✓
SD	Abortion of ectopic pregnancy	·	·	✓
SD	Cyst removal	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspepsia	✓	✓	✓
SD	Ectopic pregnancy	·	·	✓
SD	Faeces discoloured	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Ovarian cyst	·	·	✓
SD	Tooth disorder	✓	✓	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Gastritis	✓	✓	✓
SRO	Night sweats	✓	✓	✓

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