274-97132-47391

3 vaccinations 4 coded responses 26 check-ins 4 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 010 / MA
Registered: 2021-03-14

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

Timeline

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

2021-03-13
Dose 1 — Janssen/Johnson & Johnson
2021-03-14
Registered in v-safe
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-20
Health check-in — day 7, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-27
Survey response — day 14, dose 1
MedDRA: Pruritus, Rash, Self-medication, Urticaria — Feeling: Fair

Free text: Rash/hive like, high around my sides chest and back. Just began today. Mild itching, using cortisone cream and took antihistamine. No relief yet.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — day 21, single dose
MedDRA: Drug hypersensitivity, Office visit, Urticaria — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe Hives. Believed to be Reaction to medication Etodolac. Not vaccine. · Healthcare visit (other): Pcp office believed not related to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — day 21, single dose
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-10
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-05-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-06-12
Survey response — 3 months, dose 1
MedDRA: Fatigue, Office visit, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Fatigue, Consistent hard to clear sinus infections. · Healthcare visit (other): Drs. Office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Report sent to call center — 3 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Call 1 — Left Voicemail
2021-09-11
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2022-01-12
Dose 2 — Moderna
2022-03-13
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in
2022-04-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-06-17
Dose 3 — Pfizer-BioNTech
2022-06-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-06-24
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-07-01
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-07-08
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-07-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-07-22
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-07-29
Survey response — day 42, dose 3
MedDRA: Fatigue, Headache, Kidney infection, Office visit, Pain, Urinary tract infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: UTI that has progressed to kidney infection. Headaches, tiredness, body pain etc. · Healthcare visit (other): PCP office visit.

MedDRA releases: 2024-11 · check-in free text available
2022-07-29
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-01
Call 1 — Left Voicemail
2022-09-18
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-12-16
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-06-17
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Janssen/Johnson & Johnson
2	2022-01-12	Moderna	No
3	2022-06-17	Pfizer-BioNTech	No

Call center

3 call center cases

1 successful · 2 unsuccessful

See the call center timeline

Free text

Release 6 — day 14, dose 1

2021-03-27

Symptoms: Rash/hive like, high around my sides chest and back. Just began today. Mild itching, using cortisone cream and took antihistamine. No relief yet.

Release 6 — day 21, single dose

2021-04-03

Symptoms: Severe Hives. Believed to be Reaction to medication Etodolac. Not vaccine.

Healthcare visit (other): Pcp office believed not related to vaccine

Release 9 — 3 months, dose 1

2021-06-12

Symptoms: Fatigue, Consistent hard to clear sinus infections.

Healthcare visit (other): Drs. Office

Release 12 — day 42, dose 3

2022-07-29

Symptoms: UTI that has progressed to kidney infection. Headaches, tiredness, body pain etc.

Healthcare visit (other): PCP office visit.

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	Office visit	✓	✓	✓
SD	Drug hypersensitivity	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Kidney infection	·	·	✓
SD	Pain	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SD	Urticaria	✓	✓	✓

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