7S3-25773-16525

2 vaccinations 10 coded responses 14 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 926 / CA
Registered: 2021-11-03

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

Registered dependents

C4J-17016-83972 Child or adolescent in my care · Female · 2021-11-09

KCQ-11546-35319 Child or adolescent in my care · Male · 2021-11-09

WXG-14621-31028 Child or adolescent in my care · Female · 2021-11-09

Timeline

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

2021-03-30
Dose 1 — Janssen/Johnson & Johnson
2021-11-03
Registered in v-safe
2021-11-03
Dose 2 — Janssen/Johnson & Johnson
2021-11-03
Survey response — day 0, dose 2
MedDRA: Dizziness, Hypersensitivity, Immediate post-injection reaction, Presyncope — Feeling: Fair · Site: Pain

Free text: Dizziness. I almost fainted right after the injection. It felt like the beginning of anaphylaxis (and I don't mind shots)

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Good · Site: Pain, Swelling

Free text: Bruise at injection site

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Proteinuria, Reaction to previous exposure to any vaccine, Urine abnormality — Feeling: Good · Site: Swelling

Free text: I have (b)(6) ((b)(6) disease) and for the past few days since the vaccine, I've had foam in my urine (proteinuria). I had it after my first vaccine for weeks as well. I forgot to mention it before, but I did notice it.

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising, Pre-existing disease, Urine abnormality, Vaccine positive rechallenge — Feeling: Good · Site: Swelling

Free text: Bubbly urine, I have kidney disease so proteinuria (which happened after my first vaccine as wel). Also bruising around the injection site.

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Proteinuria, Reaction to previous exposure to any vaccine, Urine abnormality — Feeling: Good

Free text: Foamy urine (proteinuria), I got it after my first vaccine as well. I have (b)(6) a kidney disease, but have been in remission.

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Survey response — day 7, dose 2
MedDRA: Proteinuria, Urine abnormality — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Proteinuria (bubbly foamy urine)

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Survey response — day 14, dose 2
MedDRA: Pre-existing disease, Unevaluable event, Urine abnormality — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: More bubbly urine. I will reach out to my nephrologist. I have FSGS. · Healthcare visit (other): Message to my doctor

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-18
Call 2 — Left Voicemail
2021-11-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-02-02
Survey response — 3 months, dose 2
MedDRA: Chills, Diarrhoea, Fatigue, Headache, Myalgia, Pyrexia — Feeling: Fair · 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

Free text: Fever, chills, prolonged headache, muscle soreness, fatigue, diarrhea,

MedDRA releases: 2024-11 · check-in free text available
2022-02-02
Report sent to call center — 3 months, dose 2
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 · 1 call case(s)
2022-02-03
Call 1 — Left Voicemail
2022-05-04
Survey response — 6 months, dose 2
MedDRA: Menstruation irregular — Feeling: Good

Free text: Periods have been irregular

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Survey response — 12 months, dose 2
MedDRA: Abortion spontaneous — 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 · Emergency room or emergency department visit

Free text: Miscarriage

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-11-04
Call 1 — Left Voicemail
2022-11-04
Call 2 — Left Voicemail
2022-11-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-30	Janssen/Johnson & Johnson	No
2	2021-11-03	Janssen/Johnson & Johnson	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-17	Unsuccessful
2022-02-02	Unsuccessful
2022-11-03	Unsuccessful

Free text

Release 10 — day 0, dose 2

2021-11-03

Systemic reaction (other): Dizziness. I almost fainted right after the injection. It felt like the beginning of anaphylaxis (and I don't mind shots)

Release 10 — days 1–6 daily, dose 2

2021-11-05

Systemic reaction (other): Bruise at injection site

2021-11-06

Systemic reaction (other): I have (b)(6) ((b)(6) disease) and for the past few days since the vaccine, I've had foam in my urine (proteinuria). I had it after my first vaccine for weeks as well. I forgot to mention it before, but I did notice it.

redacted (b)(6)

2021-11-07

Systemic reaction (other): Bubbly urine, I have kidney disease so proteinuria (which happened after my first vaccine as wel). Also bruising around the injection site.

2021-11-09

Systemic reaction (other): Foamy urine (proteinuria), I got it after my first vaccine as well. I have (b)(6) a kidney disease, but have been in remission.

redacted (b)(6)

Release 10 — day 7, dose 2

2021-11-10

Systemic reaction (other): Proteinuria (bubbly foamy urine)

Release 10 — day 14, dose 2

2021-11-17

Symptoms: More bubbly urine. I will reach out to my nephrologist. I have FSGS.

Healthcare visit (other): Message to my doctor

Release 11 — 3 months, dose 2

2022-02-02

Symptoms: Fever, chills, prolonged headache, muscle soreness, fatigue, diarrhea,

Release 11 — 6 months, dose 2

2022-05-04

Symptoms: Periods have been irregular

Release 12 — 12 months, dose 2

2022-11-03

Symptoms: Miscarriage

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	Abortion spontaneous	·	·	✓
SD	Chills	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Menstruation irregular	·	·	✓
SD	Myalgia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Urine abnormality	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Hypersensitivity	·	·	✓
SRO	Immediate post-injection reaction	·	·	✓
SRO	Injection site bruising	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Presyncope	·	·	✓
SRO	Proteinuria	·	·	✓
SRO	Reaction to previous exposure to any vaccine	·	·	✓
SRO	Urine abnormality	·	·	✓
SRO	Vaccine positive rechallenge	·	·	✓

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