65N-33738-11081
1 vaccination
5 coded responses
15 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 190 / PA
- Registered
- 2021-03-07
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-06
Dose 1 — Janssen/Johnson & Johnson
-
2021-03-07
Registered in v-safe
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2021-03-07
Survey response — days 1–6 daily, dose 1MedDRA: Back pain — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: BackacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-08
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body achesAdult check-in
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2021-03-09
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-22
- 2021-03-27
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2021-04-03
Survey response — day 28, single doseMedDRA: Headache, Nasopharyngitis, Oropharyngeal pain, Productive cough, Rhinorrhoea — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree text: Runny nose, sore throat, headache, phlegm- probably a coldMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-10
Survey response — day 35, single doseMedDRA: Secretion discharge, Upper-airway cough syndrome — Feeling: GoodFree text: Post nasal drip, mucusyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-20
- 2021-06-05
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2021-09-04
Survey response — 6 months, dose 1MedDRA: Alopecia, Menstruation delayed — Feeling: GoodFree text: Hair loss, late periodMedDRA releases: 2021-09,2024-11 · check-in free text available
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2022-03-06
Survey response — 12 months, dose 1MedDRA: Menstrual disorder, Uterine dilation and curettage — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Menstrual issue · Healthcare visit (other): Surgery for d&cMedDRA releases: 2024-11 · check-in free text available
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2022-03-06
Report sent to call center — 12 months, dose 1Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
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2022-03-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-06 | Janssen/Johnson & Johnson |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-03-06 | Successful 2022-03-08 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Backache
Release 6 — day 28, single dose
Symptoms: Runny nose, sore throat, headache, phlegm- probably a cold
Release 7 — day 35, single dose
Symptoms: Post nasal drip, mucusy
Release 9 — 6 months, dose 1
Symptoms: Hair loss, late period
Release 11 — 12 months, dose 1
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 | Uterine dilation and curettage | · | · | ✓ |
| SD | Alopecia | ✓ | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Menstrual disorder | · | · | ✓ |
| SD | Menstruation delayed | ✓ | · | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Productive cough | ✓ | ✓ | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SD | Secretion discharge | ✓ | ✓ | ✓ |
| SD | Upper-airway cough syndrome | ✓ | ✓ | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release