2Q3-30772-25032

4 vaccinations 14 coded responses 30 check-ins 14 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 550 / MN
Registered: 2021-03-06

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

Registered dependents

W2G-25961-16749 Child or adolescent in my care · Male · 2021-11-05

PZS-28665-15430 Child or adolescent in my care · Female · 2021-11-05

Timeline

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

2021-03-05
Dose 1 — Janssen/Johnson & Johnson
2021-03-06
Registered in v-safe
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dysgeusia — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Different taste in my mouth i cant explain. Happened 23.5 hrs after receiving shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Taste disorder — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Altered taste.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Health check-in — day 7, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-19
Survey response — day 14, dose 1
MedDRA: Back pain, Condition aggravated, Pre-existing disease — Feeling: Good

Free text: I lateral low back pain. Right groin and leg pain down to ankle. I had gotten eid of this months ago. Now it is back and I dont know why.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 21, single dose
MedDRA: Headache, Pain — Feeling: Fair

Free text: Headache. Just today. Body aches off and on.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-04-16
Survey response — day 42, single dose
MedDRA: Pruritus — Feeling: Good

Free text: Full body itching for 3-4 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-11-05
Dose 2 — Pfizer-BioNTech
Co-administered: Pneumonia
2021-11-05
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Survey response — days 1–6 daily, dose 2
MedDRA: Chest discomfort, Dizziness, Dyspnoea — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Dizzy, SOB (today and yesterday), chest pressure (yesterday)

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-10
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Good · Fatigue or tiredness

Free text: SOB

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None · Be unable to do your normal daily activities

Adult check-in
2021-11-12
Survey response — day 7, dose 2
MedDRA: Dizziness, Nausea — Feeling: Fair · Nausea

Free text: Severe dizziness and nausea started at 4:30pm. It is now 4:52pm. Im lying in bed teying to stand up. I had half an apple.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — day 14, dose 2
MedDRA: Anxiety, Dizziness, Gait disturbance, Nausea — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Anxiety (today 11/19 moderate to severe) Dizziness with trouble walking - Severe Monday evening 11/15; Mild to moderate Tuesday 11/16; mild wednesday 11/17 Nausea - severe M evening 11/15; mild T 11/16; none Wednesday 11/17 to present day.

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Survey response — day 21, dose 2
MedDRA: Back pain, Sciatica — Feeling: Good

Free text: Sciatic. Low back pain.

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Dose 3 — Pfizer-BioNTech
2021-12-03
Survey response — day 28, dose 2
MedDRA: Fatigue, Headache, Migraine — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headache/migraine. Fatigue. Period.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2022-02-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-09-15
Dose 4 — Moderna
2022-10-13
Survey response — day 28, dose 4
MedDRA: COVID-19 — 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

Free text: Confirmed COVID-19 Tuesday October 4, 2022. Today is Day 10. The positive came 3 weeks after receiving the bivalent vax. I wear my mask indoors still. My kids wear masks to school still. Idk where I picked it up. Those who know me were very surprised

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Report sent to call center — day 28, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-20
Survey response — day 35, dose 4
MedDRA: Inflammation, Physiotherapy, Pre-existing disease — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: I tested positive for covid 10/3. I have been anxious. Stomach cramps. Headaches. I also got my period on Day 10 of covid last day of quarantine in house as I was the only one of 4 who contracted covid. None of us have had it since 2/2020. · Healthcare visit (other): PT appt PT worked on things re: inflammation etc post covid

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Report sent to call center — day 35, 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 · 1 call case(s)
2022-10-21
Call 1 — Could Not Reach Participant
2022-10-26
Call successful
Participant prefers to complete VAERS report online
2022-10-28
Survey response — day 42, dose 4
MedDRA: Acrochordon, Asthma, Breast pain, Chest discomfort, Cough, Dyspnoea, Fatigue, Office visit, Pre-existing disease, Skin discolouration — 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: Symptoms: Effortful breathing. Coughing. Asthma exacerbation. Tightness in chest. Change in color and pain or R breast skin tag. Fatigue. · Healthcare visit (other): Urgent care referred by doc tuesday 10/25/22. F/u with PAC today 10/28/22

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — day 42, 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)
2022-10-31
Call 1 — Could Not Reach Participant
2022-11-03
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Janssen/Johnson & Johnson
2	2021-11-05	Pfizer-BioNTech	Pneumonia
3	2021-11-29	Pfizer-BioNTech	No
4	2022-09-15	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): Different taste in my mouth i cant explain. Happened 23.5 hrs after receiving shot.

2021-03-08

Systemic reaction (other): Altered taste.

Release 6 — day 14, dose 1

2021-03-19

Symptoms: I lateral low back pain. Right groin and leg pain down to ankle. I had gotten eid of this months ago. Now it is back and I dont know why.

Release 6 — day 21, single dose

2021-03-26

Symptoms: Headache. Just today. Body aches off and on.

Release 7 — day 42, single dose

2021-04-16

Symptoms: Full body itching for 3-4 days.

Release 10 — days 1–6 daily, dose 2

2021-11-08

Systemic reaction (other): Dizzy, SOB (today and yesterday), chest pressure (yesterday)

2021-11-10

Systemic reaction (other): SOB

Release 10 — day 7, dose 2

2021-11-12

Systemic reaction (other): Severe dizziness and nausea started at 4:30pm. It is now 4:52pm. Im lying in bed teying to stand up. I had half an apple.

Release 10 — day 14, dose 2

2021-11-19

Symptoms: Anxiety (today 11/19 moderate to severe) Dizziness with trouble walking - Severe Monday evening 11/15; Mild to moderate Tuesday 11/16; mild wednesday 11/17 Nausea - severe M evening 11/15; mild T 11/16; none Wednesday 11/17 to present day.

Release 10 — day 21, dose 2

2021-11-26

Symptoms: Sciatic. Low back pain.

Release 10 — day 28, dose 2

2021-12-03

Symptoms: Headache/migraine. Fatigue. Period.

Release 12 — day 28, dose 4

2022-10-13

Symptoms: Confirmed COVID-19 Tuesday October 4, 2022. Today is Day 10. The positive came 3 weeks after receiving the bivalent vax. I wear my mask indoors still. My kids wear masks to school still. Idk where I picked it up. Those who know me were very surprised cut off by CDC

Release 12 — day 35, dose 4

2022-10-20

Symptoms: I tested positive for covid 10/3. I have been anxious. Stomach cramps. Headaches. I also got my period on Day 10 of covid last day of quarantine in house as I was the only one of 4 who contracted covid. None of us have had it since 2/2020.

Healthcare visit (other): PT appt PT worked on things re: inflammation etc post covid

Release 12 — day 42, dose 4

2022-10-28

Symptoms: Effortful breathing. Coughing. Asthma exacerbation. Tightness in chest. Change in color and pain or R breast skin tag. Fatigue.

Healthcare visit (other): Urgent care referred by doc tuesday 10/25/22. F/u with PAC today 10/28/22

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	Inflammation	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Physiotherapy	·	·	✓
SD	Acrochordon	·	·	✓
SD	Anxiety	·	·	✓
SD	Asthma	·	·	✓
SD	Back pain	✓	✓	✓
SD	Breast pain	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Gait disturbance	·	·	✓
SD	Headache	✓	✓	✓
SD	Migraine	·	·	✓
SD	Nausea	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Sciatica	·	·	✓
SD	Skin discolouration	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Dyspnoea	·	·	✓
SRO	Nausea	·	·	✓
SRO	Taste disorder	✓	✓	✓

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