4JV-14689-72546

3 vaccinations 27 coded responses 30 check-ins 27 free-text entries 4 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 000
Registered: 2021-02-03

Relationship: Self
Race: N/A
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-03
Registered in v-safe
2021-02-03
Dose 1 — Moderna
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Back pain — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Shoveling all day and evening lower back soreness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Epilepsy — Feeling: Fair · Chills, Diarrhea, Abdominal pain

Free text: Uncontrolled epilepsy dr (b)(6) ( (b)(6) ) Dr (b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Epilepsy — Feeling: Fair · Fatigue or tiredness, Nausea

Free text: Uncontrollable epilepsy/ no bowel movement today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: No aetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 14, dose 1
MedDRA: Headache — Feeling: Fair

Free text: Small headache all dayTemp98.8FWhy do you send to IPad and not accept? Is this safe?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — day 21, dose 1
MedDRA: Fatigue — Feeling: Fair

Free text: No bleach clean up smell No smell of cooking. . Feels nice to lay -tiredHomecare nurse came 2 times to home - check- up(Cathy). Appt for Dr Zallar AprilNot hungryHighest temp- 99.1 FReady for shot on Wed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Dose 2 — Moderna
2021-03-03
Survey response — day 0, dose 2
MedDRA: Epilepsy — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness

Free text: Uncontrollable epilepsy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature increased, Fatigue, Feeling abnormal, Thirst — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Free text: Cotton in head- tired- thirsty- tenp.100.3

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Pain — Feeling: Good · Site: Pain

Free text: Only a pinch of pain- temp - 98.3f- happy. to walk outside -no appetite( but dinner is ready)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Sudden onset of sleep — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Yesterday I unknowingly slept 5-7 pm -ate 7:30 - no appetite- why do you send out on phone and IPad and then not accept IPad- Dr appt April2- temp- 98.9

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Temp-99.1f- I slept until11:00 Ana normal- feel fine now- no appetite- eat at 6:30- you send to IPad and refuse to accept it sits there

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Fatigue — Feeling: Good · Fatigue or tiredness

Free text: Tired- no appetite- lazy to clean / scrub floors etc.( I will) temp-98.9f - home care nurse visit tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature normal, Decreased appetite, Medical counselling — Feeling: Good · Fatigue or tiredness · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Temp-99.3- home care nurse visit- no appetite- only slightly tired- I receive on IPad but it will NOT send out- submit??- · Healthcare visit (other): Home care nurse - CDC-

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-10
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Nausea, Abdominal pain

Free text: Temp- 99.6f

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-24
Survey response — day 21, dose 2
MedDRA: Body temperature increased, Epilepsy, Peripheral swelling — Feeling: Fair

Free text: Swelling in arm - 3 fingers down from shoulder- began yesterday??????I have uncontrollable epilepsyTemp- 99.5

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — day 28, dose 2
MedDRA: Acne, Induration, Nodule, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Hard marble on skin- turned to hard pea - with a cloudy pimple on top- covered with gauze and medical tape so it will not pop- Highest temp-99.1f · Healthcare visit (other): Saw home are nurse last Tuesday Sron Friday - CDC

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Survey response — day 35, dose 2
MedDRA: Adverse reaction, Medical counselling, Swelling face — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Blue spot on armTemp-97.6Bottom jaw swollen ( left and right)hy do you refuse to let me submit on IPad? I receive and copies are given to both- you are not equipped · Healthcare visit (other): Home care nurse- Dr-CDC

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

1 call case(s)
2021-04-14
Survey response — day 42, dose 2
MedDRA: Myalgia, Swelling face — Feeling: Good

Free text: Swollen jaw( left now)Arm only flat finally muscle inside sore occasionally97.5 temp

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Survey response — 3 months, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Tired for no reason

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Call 1 — Left Voicemail
2021-11-04
Dose 3 — Pfizer-BioNTech
2021-11-04
Survey response — day 0, dose 3
MedDRA: Adverse reaction — Feeling: Good

Free text: Feeling better than I assumed

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Survey response — days 1–6 daily, dose 3
MedDRA: Decreased appetite, Feeling of body temperature change, Headache, Pain in extremity, Somnolence — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Free text: No appetite/ sleepy/dull headache/ sore arm/ wore winter coat outside and two layers of sweat shirt/ then hot/ then cold

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Blister, Decreased appetite, Pain in extremity — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I got a water blister and sharp pain up and down my arm after Moderna 2 nd dose my arm - I'm hoping Pfizer booster shot does not occur with such/ I also have no appetite( yet I will eat)

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Decreased appetite, Feeling hot, Hyperhidrosis — Feeling: Good · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Free text: No appetite/ also went to hot and sweaty

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-11-09
Survey response — days 1–6 daily, dose 3
MedDRA: Decreased appetite — Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness

Free text: No appetite

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Survey response — days 1–6 daily, dose 3
MedDRA: Decreased appetite, Diarrhoea, Fatigue — Feeling: Good · Fever · Muscle or body aches, Fatigue or tiredness

Free text: Diarrhea on Sunday( not reported) thru Tuesday-( forgot to report. ) it was liquid on Monday and yesterday-- today no feces. No appetite, and just tired and get tired even walking. Better than before. No appetite-

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Survey response — day 7, dose 3
MedDRA: Epilepsy — Feeling: Good · Fever · Fatigue or tiredness, Diarrhea

Free text: Bad epileptic seizure yesterday

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — day 14, dose 3
MedDRA: Medical counselling, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: I've seen a hone care nurse- You are not accepting my account or sending codes and it is sitting on my I Oad without you taking it-, · Healthcare visit (other): Home health care nurse and on the phone to reopen myvaccount1 you are not private

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-19
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-03	Moderna
2	2021-03-03	Moderna
3	2021-11-04	Pfizer-BioNTech	No

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-05

Systemic reaction (other): Shoveling all day and evening lower back soreness

2021-02-06

Systemic reaction (other): Uncontrolled epilepsy dr (b)(6) ( (b)(6) ) Dr (b)(6)

redacted (b)(6)

2021-02-08

Systemic reaction (other): Uncontrollable epilepsy/ no bowel movement today

2021-02-09

Systemic reaction (other): No aetite

Release 4 — day 14, dose 1

2021-02-17

Symptoms: Small headache all dayTemp98.8FWhy do you send to IPad and not accept? Is this safe?

Release 4 — day 21, dose 1

2021-02-26

Symptoms: No bleach clean up smell No smell of cooking. . Feels nice to lay -tiredHomecare nurse came 2 times to home - check- up(Cathy). Appt for Dr Zallar AprilNot hungryHighest temp- 99.1 FReady for shot on Wed

Release 4 — day 0, dose 2

2021-03-03

Systemic reaction (other): Uncontrollable epilepsy.

Release 5 — days 1–6 daily, dose 2

2021-03-04

Systemic reaction (other): Cotton in head- tired- thirsty- tenp.100.3

2021-03-05

Systemic reaction (other): Only a pinch of pain- temp - 98.3f- happy. to walk outside -no appetite( but dinner is ready)

2021-03-06

Systemic reaction (other): Yesterday I unknowingly slept 5-7 pm -ate 7:30 - no appetite- why do you send out on phone and IPad and then not accept IPad- Dr appt April2- temp- 98.9

2021-03-07

Systemic reaction (other): Temp-99.1f- I slept until11:00 Ana normal- feel fine now- no appetite- eat at 6:30- you send to IPad and refuse to accept it sits there

2021-03-08

Systemic reaction (other): Tired- no appetite- lazy to clean / scrub floors etc.( I will) temp-98.9f - home care nurse visit tomorrow

2021-03-09

Systemic reaction (other): Temp-99.3- home care nurse visit- no appetite- only slightly tired- I receive on IPad but it will NOT send out- submit??-

Healthcare visit (other): Home care nurse - CDC-

Release 5 — day 7, dose 2

2021-03-10

Systemic reaction (other): Temp- 99.6f

Release 6 — day 21, dose 2

2021-03-24

Symptoms: Swelling in arm - 3 fingers down from shoulder- began yesterday??????I have uncontrollable epilepsyTemp- 99.5

Release 6 — day 28, dose 2

2021-03-31

Symptoms: Hard marble on skin- turned to hard pea - with a cloudy pimple on top- covered with gauze and medical tape so it will not pop- Highest temp-99.1f

Healthcare visit (other): Saw home are nurse last Tuesday Sron Friday - CDC

Release 7 — day 35, dose 2

2021-04-09

Symptoms: Blue spot on armTemp-97.6Bottom jaw swollen ( left and right)hy do you refuse to let me submit on IPad? I receive and copies are given to both- you are not equipped

Healthcare visit (other): Home care nurse- Dr-CDC

Release 7 — day 42, dose 2

2021-04-14

Symptoms: Swollen jaw( left now)Arm only flat finally muscle inside sore occasionally97.5 temp

Release 8 — 3 months, dose 2

2021-06-02

Symptoms: Tired for no reason

Release 10 — day 0, dose 3

2021-11-04

Systemic reaction (other): Feeling better than I assumed

Release 10 — days 1–6 daily, dose 3

2021-11-05

Systemic reaction (other): No appetite/ sleepy/dull headache/ sore arm/ wore winter coat outside and two layers of sweat shirt/ then hot/ then cold

2021-11-06

Systemic reaction (other): I got a water blister and sharp pain up and down my arm after Moderna 2 nd dose my arm - I'm hoping Pfizer booster shot does not occur with such/ I also have no appetite( yet I will eat)

2021-11-07

Systemic reaction (other): No appetite/ also went to hot and sweaty

2021-11-09

Systemic reaction (other): No appetite

2021-11-10

Systemic reaction (other): Diarrhea on Sunday( not reported) thru Tuesday-( forgot to report. ) it was liquid on Monday and yesterday-- today no feces. No appetite, and just tired and get tired even walking. Better than before. No appetite-

Release 10 — day 7, dose 3

2021-11-16

Systemic reaction (other): Bad epileptic seizure yesterday

Release 10 — day 14, dose 3

2021-11-18

Symptoms: I've seen a hone care nurse- You are not accepting my account or sending codes and it is sitting on my I Oad without you taking it-,

Healthcare visit (other): Home health care nurse and on the phone to reopen myvaccount1 you are not private

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Acne	✓	✓	✓
SD	Adverse reaction	✓	✓	✓
SD	Body temperature increased	✓	✓	✓
SD	Epilepsy	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Induration	✓	✓	✓
SD	Medical counselling	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nodule	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Swelling face	✓	✓	✓
SD	Unevaluable event	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Blister	·	·	✓
SRO	Body temperature increased	✓	✓	✓
SRO	Body temperature normal	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Diarrhoea	·	·	✓
SRO	Epilepsy	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Feeling hot	·	·	✓
SRO	Feeling of body temperature change	·	·	✓
SRO	Headache	·	·	✓
SRO	Hyperhidrosis	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Somnolence	·	·	✓
SRO	Sudden onset of sleep	✓	✓	✓
SRO	Thirst	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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