4CV-27667-86251

2 vaccinations 24 coded responses 30 check-ins 24 free-text entries 9 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 920 / CA
Registered: 2021-04-09

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

2021-04-09
Registered in v-safe
2021-04-09
Dose 1 — Janssen/Johnson & Johnson
2021-04-09
Survey response — day 0, dose 1
MedDRA: Immediate post-injection reaction, Lymphadenopathy, Pruritus — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Itching along veins in arms legs, lymph node swelling in arm where shot was given about 5 minutes after injection .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Chest discomfort, Flushing, Headache, Lymphadenopathy, Vision blurred — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Facial flushing, lymph node swelling, upper chest tightness(most likely from lymph swelling) blurry vision from headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 1
MedDRA: Neuralgia — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Nerve pain irritation throughout body

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Hepatic pain, Hepatitis, Injection site induration, Injection site warmth, Neurological symptom, Pain, Pruritus, Unevaluable event — Feeling: Poor · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Injection site hard and hot to touch. Massive nerulogical issues, continuing headache , liver swollen and sore , itching along spine, burning pain throughout body (neuro) · Healthcare visit (other): Blood work to check platelet activity as precautionary measure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site warmth, Neuralgia, Neuropathy peripheral, Pruritus — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Injection site is hot to touch still. Brain and limbs - Confined neuropathy - Burning nerve pain throughout body. Itching along spinal cord continues .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Groin pain, Hepatic pain, Injection site induration, Injection site pruritus, Injection site warmth, Neuralgia, Pain, Pain in extremity, Pruritus, Swelling — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Neurological pain, searing brining stinging pain along inside tight leg and right groin, nerve pain in arms, injection site hot to touch, hard, itching , itching along spine, liver area swelling and pain,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 7, dose 1
MedDRA: Abdominal distension, Abdominal pain lower, Hepatitis, Myalgia — Feeling: Poor · Headache, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Free text: Liver feels swollen a d inflamed, bloating, abdominal muscle pain lower abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — day 14, dose 1
MedDRA: Fatigue, Headache, Hepatitis, Hypertension, Neurological symptom, Pain, Swelling, Unevaluable event, Visual impairment — 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: Symptoms: High blood pressure, high pressure headaches vision disturbances (blurry) from pressure, liver inflammation (pain, swelling, fatigue, continued neuro symptoms. · Healthcare visit (other): Lab work - blood platelet CBC check

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
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)
2021-04-30
Survey response — day 21, single dose
MedDRA: Fatigue, Hepatic pain, Immediate post-injection reaction, Lymphadenopathy, Nervous system disorder, Swelling, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Fatigue and neuro problems increasing to current possible HPV/MA/ lupus flare (need blood work to fully diagnose so not Sure). Liver swollen and achy confining but not worsening - random lymph swelling continuing ever since 5 min after vaccine. · Healthcare visit (other): Blood work Drs appt pending

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
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)
2021-05-07
Health check-in — day 28, single dose
Feeling: Fair

Adult check-in
2021-05-14
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-05-21
Survey response — day 42, single dose
MedDRA: Arthralgia, Condition aggravated, Head discomfort, Headache, Myalgia, Pre-existing disease, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Muscle joint pain, headache and skull pressure. Skin lupus type flare . Believe vaccinations in general are causing symptom flares not just necessarily Covid vaccine. · Healthcare visit (other): Scheduled appointments and lab work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Report sent to call center — day 42, single dose
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-29
Call 2 — Left Voicemail
2021-06-14
Call 3 — Left Voicemail
2021-07-09
Health check-in — 3 months, dose 1
Feeling: Fair

Adult check-in
2021-10-08
Survey response — 6 months, dose 1
MedDRA: Skin discolouration — Feeling: Fair

Free text: Weird skin discoloration in large patches

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Dose 2 — Moderna
2021-11-17
Survey response — days 1–6 daily, dose 2
MedDRA: Neuralgia — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Nerve pain-

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Neuralgia, Pain, Spinal pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Burning searing spinal and chest pain (nerves)

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — days 1–6 daily, dose 2
MedDRA: Neuralgia, Pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Still have burning nerve pain in upper chest and upper spine

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Dyspnoea, Neuralgia, Vertigo — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Vertigo, dizziness breathing difficulties, nerve pain

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure abnormal, Nervous system disorder — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Nerve issues, blood pressure issues,

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Survey response — days 1–6 daily, dose 2
MedDRA: Nervous system disorder — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Nerve issues in upper spine continuing

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain, Redness, Itching · Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Nerve

MedDRA releases: 2024-11 · check-in free text available
2021-11-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-12-07
Survey response — day 21, dose 2
MedDRA: Arthropathy, Gait inability, Injury, Spinal disorder, Yellow skin — 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: yellowing skin spine and joint issues unable to physically walk (not sure what I did to cause injury )

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Report sent to call center — day 21, dose 2
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)
2021-12-09
Call 2 — Left Voicemail
2021-12-14
Survey response — day 28, dose 2
MedDRA: Injection site mass, Injection site pain, Injection site pruritus, Injection site rash, Injection site warmth, Pre-existing disease, Rash pruritic — Feeling: Fair · Be unable to do your normal daily activities

Free text: "Moderna" arm reactivating after it had gone away complet . Sudden (within 30 min) rising of vaccine lump on arm and heat, sig. pain and rash with itching. It had gone away so this re-activation was very surprising. 24 hrs later got better again

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-12-28
Survey response — day 42, dose 2
MedDRA: Muscle disorder, Pre-existing disease, Rash, Rash erythematous, Tendon disorder — 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

Free text: Weird rashes - Moderna arm has a permanent red rash (over 8 weeks) - muscle /tendon issues other issues not related to vaccine (orthopedic and normal daily chronic illness issues)

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Report sent to call center — day 42, dose 2
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 · 1 call case(s)
2021-12-29
Call 2 — Left Voicemail
2021-12-30
Call successful
Does not wish to fill out VAERS report
2021-12-30
Call successful
Does not wish to fill out VAERS report
2021-12-30
Call successful
Does not wish to fill out VAERS report
2021-12-30
Call successful
Does not wish to fill out VAERS report
2021-12-30
Call successful
Does not wish to fill out VAERS report
2021-12-30
Call successful
Does not wish to fill out VAERS report
2022-02-17
Survey response — 3 months, dose 2
MedDRA: Rash, Unevaluable event — 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

Free text: Symptoms: Weird rashes - possible autoimmune flare · Healthcare visit (other): Blood work , prescription meds

MedDRA releases: 2024-11 · check-in free text available
2022-02-17
Report sent to call center — 3 months, dose 2
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)
2022-02-23
Call 1 — Left Voicemail
2022-05-17
Survey response — 6 months, dose 2
MedDRA: Hypersensitivity, Immune system disorder, Office visit — 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: Symptoms: severe systemic allergic reactions including severe neurological reactions to to topical antibiotics (multiple) requiring prednisone treatment over multiple days - MrNA booster ramped up Immune system too much issues ever since · Healthcare visit (other): Made in person Drs spots with multiple treating physicians on emergency basis

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Report sent to call center — 6 months, dose 2
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)
2022-05-18
Call 1 — Left Voicemail
2022-05-18
Call 1 — Left Voicemail
2022-05-18
Call 1 — Left Voicemail
2022-05-18
Call 1 — Left Voicemail
2022-05-18
Call 1 — Left Voicemail
2022-05-18
Call 1 — Left Voicemail
2022-05-18
Call 2 — Left Voicemail
2022-05-18
Call 1 — Left Voicemail
2022-11-16
Survey response — 12 months, dose 2
MedDRA: Hypersensitivity, Migraine, Office visit, Unevaluable event — 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, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: NEW Cluster migraines - neurologist is trying to determine cause Also severe new hypersensitivities ever since Moderna Booster. to pint here I have been told no more MRNA vaccinations for me by all my doctors · Healthcare visit (other): Imaging and steroid medication

MedDRA releases: 2024-11 · check-in free text available
2022-11-16
Report sent to call center — 12 months, dose 2
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 · 1 call case(s)
2022-11-17
Call 3 — Left Voicemail
2022-11-17
Call 2 — Left Voicemail
2022-11-17
Call 1 — Left Voicemail
2022-11-17
Call successful
Does not wish to fill out VAERS report
2022-11-17
Call successful
Does not wish to fill out VAERS report
2022-11-17
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-09	Janssen/Johnson & Johnson
2	2021-11-16	Moderna	No

Call center

9 call center cases

9 successful

3 waits over 3 months for a first call

See the call center timeline

Free text

Release 7 — day 0, dose 1

2021-04-09

Systemic reaction (other): Itching along veins in arms legs, lymph node swelling in arm where shot was given about 5 minutes after injection .

Release 7 — days 1–6 daily, dose 1

2021-04-10

Systemic reaction (other): Facial flushing, lymph node swelling, upper chest tightness(most likely from lymph swelling) blurry vision from headache

2021-04-11

Systemic reaction (other): Nerve pain irritation throughout body

2021-04-13

Systemic reaction (other): Injection site hard and hot to touch. Massive nerulogical issues, continuing headache , liver swollen and sore , itching along spine, burning pain throughout body (neuro)

Healthcare visit (other): Blood work to check platelet activity as precautionary measure

2021-04-14

Systemic reaction (other): Injection site is hot to touch still. Brain and limbs - Confined neuropathy - Burning nerve pain throughout body. Itching along spinal cord continues .

2021-04-15

Systemic reaction (other): Neurological pain, searing brining stinging pain along inside tight leg and right groin, nerve pain in arms, injection site hot to touch, hard, itching , itching along spine, liver area swelling and pain,

Release 7 — day 7, dose 1

2021-04-16

Systemic reaction (other): Liver feels swollen a d inflamed, bloating, abdominal muscle pain lower abdominal pain

Release 7 — day 14, dose 1

2021-04-23

Symptoms: High blood pressure, high pressure headaches vision disturbances (blurry) from pressure, liver inflammation (pain, swelling, fatigue, continued neuro symptoms.

Healthcare visit (other): Lab work - blood platelet CBC check

Release 8 — day 21, single dose

2021-04-30

Symptoms: Fatigue and neuro problems increasing to current possible HPV/MA/ lupus flare (need blood work to fully diagnose so not Sure). Liver swollen and achy confining but not worsening - random lymph swelling continuing ever since 5 min after vaccine.

Healthcare visit (other): Blood work Drs appt pending

Release 8 — day 42, single dose

2021-05-21

Symptoms: Muscle joint pain, headache and skull pressure. Skin lupus type flare . Believe vaccinations in general are causing symptom flares not just necessarily Covid vaccine.

Healthcare visit (other): Scheduled appointments and lab work

Release 10 — 6 months, dose 1

2021-10-08

Symptoms: Weird skin discoloration in large patches

Release 10 — days 1–6 daily, dose 2

2021-11-17

Systemic reaction (other): Nerve pain-

2021-11-18

Systemic reaction (other): Burning searing spinal and chest pain (nerves)

2021-11-19

Systemic reaction (other): Still have burning nerve pain in upper chest and upper spine

2021-11-20

Systemic reaction (other): Vertigo, dizziness breathing difficulties, nerve pain

2021-11-21

Systemic reaction (other): Nerve issues, blood pressure issues,

2021-11-22

Systemic reaction (other): Nerve issues in upper spine continuing

Release 10 — day 7, dose 2

2021-11-23

Systemic reaction (other): Nerve

Release 10 — day 21, dose 2

2021-12-07

Symptoms: yellowing skin spine and joint issues unable to physically walk (not sure what I did to cause injury )

Release 10 — day 28, dose 2

2021-12-14

Symptoms: "Moderna" arm reactivating after it had gone away complet . Sudden (within 30 min) rising of vaccine lump on arm and heat, sig. pain and rash with itching. It had gone away so this re-activation was very surprising. 24 hrs later got better again cut off by CDC

Release 10 — day 42, dose 2

2021-12-28

Symptoms: Weird rashes - Moderna arm has a permanent red rash (over 8 weeks) - muscle /tendon issues other issues not related to vaccine (orthopedic and normal daily chronic illness issues)

Release 11 — 3 months, dose 2

2022-02-17

Symptoms: Weird rashes - possible autoimmune flare

Healthcare visit (other): Blood work , prescription meds

Release 11 — 6 months, dose 2

2022-05-17

Symptoms: severe systemic allergic reactions including severe neurological reactions to to topical antibiotics (multiple) requiring prednisone treatment over multiple days - MrNA booster ramped up Immune system too much issues ever since

Healthcare visit (other): Made in person Drs spots with multiple treating physicians on emergency basis

Release 12 — 12 months, dose 2

2022-11-16

Symptoms: NEW Cluster migraines - neurologist is trying to determine cause Also severe new hypersensitivities ever since Moderna Booster. to pint here I have been told no more MRNA vaccinations for me by all my doctors

Healthcare visit (other): Imaging and steroid medication

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	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Arthropathy	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait inability	·	·	✓
SD	Head discomfort	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hepatic pain	✓	✓	✓
SD	Hepatitis	✓	✓	✓
SD	Hypersensitivity	·	·	✓
SD	Hypertension	✓	✓	✓
SD	Immediate post-injection reaction	✓	✓	✓
SD	Immune system disorder	·	·	✓
SD	Injection site mass	·	·	✓
SD	Injection site pain	·	·	✓
SD	Injection site pruritus	·	·	✓
SD	Injection site rash	·	·	✓
SD	Injection site warmth	·	·	✓
SD	Injury	·	·	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Migraine	·	·	✓
SD	Muscle disorder	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nervous system disorder	✓	✓	✓
SD	Neurological symptom	✓	✓	✓
SD	Office visit	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	·	·	✓
SD	Rash erythematous	·	·	✓
SD	Rash pruritic	·	·	✓
SD	Skin discolouration	·	·	✓
SD	Spinal disorder	·	·	✓
SD	Swelling	✓	✓	✓
SD	Tendon disorder	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Visual impairment	✓	✓	✓
SD	Yellow skin	·	·	✓
SRO	Abdominal distension	✓	✓	✓
SRO	Abdominal pain lower	✓	✓	✓
SRO	Blood pressure abnormal	·	·	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Chest pain	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Flushing	✓	✓	✓
SRO	Groin pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hepatic pain	✓	✓	✓
SRO	Hepatitis	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Injection site induration	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Nervous system disorder	·	·	✓
SRO	Neuralgia	✓	✓	✓
SRO	Neurological symptom	✓	✓	✓
SRO	Neuropathy peripheral	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Spinal pain	·	·	✓
SRO	Swelling	✓	✓	✓
SRO	Unevaluable event	·	·	✓
SRO	Vertigo	·	·	✓
SRO	Vision blurred	✓	✓	✓

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