2JH-33432-17085

5 vaccinations 16 coded responses 59 check-ins 16 free-text entries 7 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 119 / NY
Registered: 2021-03-11

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

Registered dependents

HP4-23314-93282 Adult relative or friend · Male · 2021-09-10

Timeline

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

2021-03-10
Dose 1 — Moderna
2021-03-11
Registered in v-safe
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 21, dose 1
Feeling: Poor

Adult check-in
2021-04-07
Dose 2 — Moderna
2021-04-07
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Tremor — Feeling: Poor · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Chills made my teeth chatter & entire body shake so bad, I couldn't inject my insulin so my diabetes is worse. Couldn't brush teeth or anything. I was literally knocked off my feet to bed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-14
Survey response — day 7, dose 2
MedDRA: Blood glucose decreased — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Very low blood sugars between 63- 73.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — day 14, dose 2
MedDRA: Fatigue, Headache — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache, profound fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — day 21, dose 2
MedDRA: Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: I got pneumovax 23 yesterday & arm is so sore, I am on Percocet. Not even helping my pain. Had pneumovax 23 in 2005 & 2015 & never had this kind of mind- blowing pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Survey response — day 28, dose 2
MedDRA: Abdominal pain lower, Medical counselling, Mobility decreased — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Severe pain in my lower left abdomen for last few days left me bedridden. My rheumatologist thinks it's diverticulitis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-13
Survey response — day 35, dose 2
MedDRA: Diverticulitis, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Severe diverticulitis, mild right upper arm pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-19
Health check-in — day 42, dose 2
Feeling: Poor

Adult check-in
2021-07-07
Survey response — 3 months, dose 2
MedDRA: Gastrointestinal disorder — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Autoimmune gastrointestinal dysmotility disorder.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-07
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-09
Call 1 — Left Voicemail
2021-08-20
Dose 3 — Moderna
2021-08-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-22
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-23
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site reaction, Rash erythematous — Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Severe red rash around injection site since injection. I didn't notice it until I looked in mirror on Sunday at my arm & realized it was red since injection.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-24
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-26
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-27
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-09-03
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-09-10
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-09-18
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-09-24
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-10-03
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-11-19
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-02-02
Dose 4 — Moderna
2022-02-02
Health check-in — day 0, dose 4
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-02-03
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling · None

Adult check-in
2022-02-04
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling · None

Adult check-in
2022-02-05
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling · None

Adult check-in
2022-02-07
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · None

Adult check-in
2022-02-08
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling · None

Adult check-in
2022-02-09
Health check-in — day 7, dose 4
Feeling: Fair · None

Adult check-in
2022-02-16
Health check-in — day 14, dose 4
Feeling: Poor

Adult check-in
2022-02-23
Survey response — day 21, dose 4
MedDRA: Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities

Free text: Being threatened by my husband.

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Survey response — day 28, dose 4
MedDRA: Depression — Feeling: Fair · Be unable to do your normal daily activities

Free text: Depression.

MedDRA releases: 2024-11 · check-in free text available
2022-03-09
Survey response — day 35, dose 4
MedDRA: Depression — Feeling: Poor · Be unable to do your normal daily activities

Free text: Depression.

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Survey response — day 42, dose 4
MedDRA: Major depression — Feeling: Poor · Be unable to do your normal daily activities

Free text: Major depressive disorder.

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — 3 months, dose 4
MedDRA: Feeling of despair, Sleep disorder — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Losing hope, sleeping around.

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-03
Survey response — 6 months, dose 4
MedDRA: Anxiety, Condition aggravated, Gastrointestinal disorder, Major depression, Pre-existing disease — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Worsening of major depressive disorder, PTSD, OCD, anxiety, digestive problems.

MedDRA releases: 2024-11 · check-in free text available
2022-08-03
Report sent to call center — 6 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-08-04
Call 1 — Left Voicemail
2022-08-04
Call 1 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 1 — Left Voicemail
2022-08-04
Call 1 — Left Voicemail
2022-08-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-15
Dose 5 — Moderna
2022-11-16
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-11-18
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-11-19
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-11-20
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-11-23
Health check-in — day 7, dose 5
Feeling: Poor · Site: Swelling · Fatigue or tiredness

Adult check-in
2022-11-29
Health check-in — day 14, dose 5
Feeling: Poor

Adult check-in
2022-12-06
Health check-in — day 21, dose 5
Feeling: Poor

Adult check-in
2022-12-13
Health check-in — day 28, dose 5
Feeling: Poor

Adult check-in
2022-12-20
Survey response — day 35, dose 5
MedDRA: SARS-CoV-2 test positive — Feeling: Poor · 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: Tested positive for Covid-19 on Fri., Dec. 16. Totally shocked & traumatized.

MedDRA releases: 2024-11 · check-in free text available
2022-12-20
Report sent to call center — day 35, dose 5
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)
2022-12-21
Call 1 — Left Voicemail
2022-12-27
Survey response — day 42, dose 5
MedDRA: SARS-CoV-2 test positive — Feeling: Fair · 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: Tested positive for covid-19 on Dec. 16, 2022.

MedDRA releases: 2024-11 · check-in free text available
2022-12-27
Report sent to call center — day 42, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-12-28
Call 2 — Left Voicemail
2022-12-28
Call 1 — Left Voicemail
2023-01-16
Call successful
Does not wish to fill out VAERS report
2023-01-16
Call successful
Does not wish to fill out VAERS report
2023-02-14
Health check-in — 3 months, dose 5
Feeling: Poor

Adult check-in
2023-05-17
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Moderna
2	2021-04-07	Moderna
3	2021-08-20	Moderna	No
4	2022-02-02	Moderna	No
5	2022-11-15	Moderna	No

Call center

7 call center cases

7 successful

3 waits over 3 months for a first call

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-09

Systemic reaction (other): Chills made my teeth chatter & entire body shake so bad, I couldn't inject my insulin so my diabetes is worse. Couldn't brush teeth or anything. I was literally knocked off my feet to bed.

Release 7 — day 7, dose 2

2021-04-14

Systemic reaction (other): Very low blood sugars between 63- 73.

Release 7 — day 14, dose 2

2021-04-21

Symptoms: Headache, profound fatigue.

Release 8 — day 21, dose 2

2021-04-28

Symptoms: I got pneumovax 23 yesterday & arm is so sore, I am on Percocet. Not even helping my pain. Had pneumovax 23 in 2005 & 2015 & never had this kind of mind- blowing pain.

Release 8 — day 28, dose 2

2021-05-06

Symptoms: Severe pain in my lower left abdomen for last few days left me bedridden. My rheumatologist thinks it's diverticulitis.

Release 8 — day 35, dose 2

2021-05-13

Symptoms: Severe diverticulitis, mild right upper arm pain.

Release 9 — 3 months, dose 2

2021-07-07

Symptoms: Autoimmune gastrointestinal dysmotility disorder.

Release 9 — days 1–6 daily, dose 3

2021-08-23

Systemic reaction (other): Severe red rash around injection site since injection. I didn't notice it until I looked in mirror on Sunday at my arm & realized it was red since injection.

Release 11 — day 21, dose 4

2022-02-23

Symptoms: Being threatened by my husband.

Release 11 — day 28, dose 4

2022-03-02

Symptoms: Depression.

Release 11 — day 35, dose 4

2022-03-09

Symptoms: Depression.

Release 11 — day 42, dose 4

2022-03-16

Symptoms: Major depressive disorder.

Release 11 — 3 months, dose 4

2022-05-04

Symptoms: Losing hope, sleeping around.

Release 12 — 6 months, dose 4

2022-08-03

Symptoms: Worsening of major depressive disorder, PTSD, OCD, anxiety, digestive problems.

Release 12 — day 35, dose 5

2022-12-20

Symptoms: Tested positive for Covid-19 on Fri., Dec. 16. Totally shocked & traumatized.

Release 12 — day 42, dose 5

2022-12-27

Symptoms: Tested positive for covid-19 on Dec. 16, 2022.

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
SD	Abdominal pain lower	✓	✓	✓
SD	Anxiety	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Depression	·	·	✓
SD	Diverticulitis	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling of despair	·	·	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Major depression	·	·	✓
SD	Medical counselling	✓	✓	✓
SD	Mobility decreased	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sleep disorder	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Blood glucose decreased	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Injection site reaction	✓	·	✓
SRO	Rash erythematous	✓	·	✓
SRO	Tremor	✓	✓	✓

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