3D7-21510-48940

1 vaccination 7 coded responses 9 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 385 / TN
Registered: 2021-07-15

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

Timeline

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

2021-07-13
Dose 1 — Moderna
2021-07-15
Registered in v-safe
2021-07-15
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-07-16
Survey response — days 1–6 daily, dose 1
MedDRA: Brain fog, Feeling hot, Infection — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Brain Fog. Warmth spreading from infection site

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-17
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site warmth — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Warmth around injection site spreading across upper arm.

MedDRA releases: 2024-11 · check-in free text available
2021-07-19
Survey response — days 1–6 daily, dose 1
MedDRA: Brain fog, Diarrhoea, Migraine — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Diarrhea 20+ times daily. Brain Fog. Extreme migraine.

MedDRA releases: 2024-11 · check-in free text available
2021-07-20
Health check-in — day 7, dose 1
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-07-27
Survey response — day 14, dose 1
MedDRA: Colitis ulcerative, Diarrhoea haemorrhagic, Pre-existing condition improved, Rectal haemorrhage, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Ulcerative Colitis flare. Losing blood from bowels. Severe bloody diarrhea. · Healthcare visit (other): Scheduling appointment with Ulcerative Colitis/GI Specialist at (b)(6)

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-27
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-04
Call successful
Participant prefers to complete VAERS report online
2021-08-17
Survey response — day 35, dose 1
MedDRA: Blood potassium decreased, Condition aggravated, Dehydration, Diarrhoea haemorrhagic, Hospitalisation, Mucous stools, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Currently hospitalized for Ulcerative Colitis flare, critically low potassium, bloody/mucus diarrhea, severe dehydration

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-17
Report sent to call center — day 35, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-20
Call successful
Does not wish to fill out VAERS report
2022-01-13
Survey response — 6 months, dose 1
MedDRA: Central venous catheterisation, Faecal calprotectin increased, Gastrointestinal disorder, Gastrointestinal tube insertion, Jejunostomy — 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, Emergency room or emergency department visit, Hospitalization

Free text: I now have my second J Tube and have had 4 NG Tubes since August 2021. My digestive system is not working properly. My fecal calprotectin level is currently 182. I did have a PICC line to administer TPN and potassium infusions.

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Report sent to call center — 6 months, dose 1
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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-01-19
Call 1 — Left Voicemail
2022-07-15
Survey response — 12 months, dose 1
MedDRA: Blood urine present, Cervical cyst, Condition aggravated, Gastrointestinal disorder, Oesophageal stenosis, Pre-existing disease, Unevaluable event, Urinary tract infection, pH urine increased — 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Chronic, hard to treat UTIs, high urine PH, blood in urine, and possible kidney stones. 3 rounds of antibiotics in 2+ months. Ovarian cyst doubled in size. Cysts on cervix. Esophageal Stenosis/stricture. Digestive issues/J Tube · Healthcare visit (other): Outpatient procedures and tests

MedDRA releases: 2024-11 · check-in free text available
2022-07-15
Report sent to call center — 12 months, dose 1
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 · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-07-18
Call 1 — Left Voicemail
2022-07-18
Call 1 — Left Voicemail
2022-07-18
Call 2 — Left Voicemail
2022-07-18
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-13	Moderna	No

Call center

4 call center cases

2 successful · 2 unsuccessful

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 9 — days 1–6 daily, dose 1

2021-07-16

Systemic reaction (other): Brain Fog. Warmth spreading from infection site

2021-07-17

Systemic reaction (other): Warmth around injection site spreading across upper arm.

2021-07-19

Systemic reaction (other): Diarrhea 20+ times daily. Brain Fog. Extreme migraine.

Release 9 — day 14, dose 1

2021-07-27

Symptoms: Ulcerative Colitis flare. Losing blood from bowels. Severe bloody diarrhea.

Healthcare visit (other): Scheduling appointment with Ulcerative Colitis/GI Specialist at (b)(6)

redacted (b)(6)

Release 9 — day 35, dose 1

2021-08-17

Symptoms: Currently hospitalized for Ulcerative Colitis flare, critically low potassium, bloody/mucus diarrhea, severe dehydration

Release 10 — 6 months, dose 1

2022-01-13

Symptoms: I now have my second J Tube and have had 4 NG Tubes since August 2021. My digestive system is not working properly. My fecal calprotectin level is currently 182. I did have a PICC line to administer TPN and potassium infusions.

Release 12 — 12 months, dose 1

2022-07-15

Symptoms: Chronic, hard to treat UTIs, high urine PH, blood in urine, and possible kidney stones. 3 rounds of antibiotics in 2+ months. Ovarian cyst doubled in size. Cysts on cervix. Esophageal Stenosis/stricture. Digestive issues/J Tube

Healthcare visit (other): Outpatient procedures and tests

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	Blood potassium decreased	✓	·	✓
SD	Blood urine present	·	·	✓
SD	Central venous catheterisation	·	·	✓
SD	Cervical cyst	·	·	✓
SD	Colitis ulcerative	✓	·	✓
SD	Condition aggravated	✓	·	✓
SD	Dehydration	✓	·	✓
SD	Diarrhoea haemorrhagic	✓	·	✓
SD	Faecal calprotectin increased	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Gastrointestinal tube insertion	·	·	✓
SD	Hospitalisation	✓	·	✓
SD	Jejunostomy	·	·	✓
SD	Mucous stools	✓	·	✓
SD	Oesophageal stenosis	·	·	✓
SD	pH urine increased	·	·	✓
SD	Pre-existing condition improved	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Rectal haemorrhage	✓	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Brain fog	✓	·	✓
SRO	Diarrhoea	·	·	✓
SRO	Feeling hot	✓	·	✓
SRO	Infection	✓	·	✓
SRO	Injection site warmth	·	·	✓
SRO	Migraine	·	·	✓

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