3UE-14201-12427

4 vaccinations 5 coded responses 25 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 916 / CA
Registered: 2021-04-28

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-04-01
Dose 1 — Janssen/Johnson & Johnson
2021-04-28
Registered in v-safe
2021-04-28
Health check-in — day 21, single dose
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-07-03
Survey response — 3 months, dose 1
MedDRA: Pre-existing disease, Surgery — 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 · Hospitalization

Free text: On 6/17/21 I had Surgery: Anterior Cervical Discectomy, Fusion & Titanium Implants at 4 Levels!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Report sent to call center — 3 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

1 call case(s)
2021-07-09
Call 1 — Left Voicemail
2021-10-02
Survey response — 6 months, dose 1
MedDRA: SARS-CoV-2 test — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: 9/28/21 my roommate came home from 1 weeks vacation in Monterey, CA Jazz Festival. By 9/30/21 he was feeling sick. 10/2/21 we all went to have COVID-19 mRNR tests. Hes Moderna Fully Vaxd Im J,J&J Fully Vaxd. His daughter had Covid 1/21 No · Healthcare visit (other): Went to get COVID-19 mRNR Test 10/2/21

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-07
Call 1 — Left Voicemail
2021-10-12
Call successful
Not applicable - Accidental Reporting
2021-11-19
Dose 2 — Pfizer-BioNTech
2022-04-01
Health check-in — 12 months, dose 1
Feeling: Fair

Adult check-in
2022-05-06
Dose 3 — Pfizer-BioNTech
2022-05-06
Survey response — day 0, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No thank you.

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-05-13
Health check-in — day 7, dose 3
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2022-05-22
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-05-28
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-06-10
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-06-17
Survey response — day 42, dose 3
MedDRA: Throat irritation — Feeling: Fair

Free text: Scratchy throat

MedDRA releases: 2024-11 · check-in free text available
2022-08-05
Survey response — 3 months, dose 3
MedDRA: Hospitalisation, SARS-CoV-2 test negative, Spinal laminectomy — 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 · Hospitalization

Free text: I've had two bilateral laminectomies on 7/14/22. I'm Still in Hospital. I tested negative for COVID-19

MedDRA releases: 2024-11 · check-in free text available
2022-08-05
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Hospitalization · 1 call case(s)
2022-08-08
Call 1 — Requested Callback
2022-09-14
Dose 4 — Pfizer-BioNTech
2022-09-29
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-05
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-15
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-14
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-15
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-01	Janssen/Johnson & Johnson
2	2021-11-19	Pfizer-BioNTech	No
3	2022-05-06	Pfizer-BioNTech	No
4	2022-09-14	Pfizer-BioNTech	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 9 — 3 months, dose 1

2021-07-03

Symptoms: On 6/17/21 I had Surgery: Anterior Cervical Discectomy, Fusion & Titanium Implants at 4 Levels!

Release 9 — 6 months, dose 1

2021-10-02

Symptoms: 9/28/21 my roommate came home from 1 weeks vacation in Monterey, CA Jazz Festival. By 9/30/21 he was feeling sick. 10/2/21 we all went to have COVID-19 mRNR tests. Hes Moderna Fully Vaxd Im J,J&J Fully Vaxd. His daughter had Covid 1/21 No

Healthcare visit (other): Went to get COVID-19 mRNR Test 10/2/21

Release 11 — day 0, dose 3

2022-05-06

Systemic reaction (other): No thank you.

Release 12 — day 42, dose 3

2022-06-17

Symptoms: Scratchy throat

Release 12 — 3 months, dose 3

2022-08-05

Symptoms: I've had two bilateral laminectomies on 7/14/22. I'm Still in Hospital. I tested negative for COVID-19

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	SARS-CoV-2 test	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	SARS-CoV-2 test	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Spinal laminectomy	·	·	✓
SD	Surgery	✓	✓	✓
SD	Throat irritation	·	·	✓
SRO	No adverse event	·	·	✓

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