4JX-39092-78475
3 vaccinations
9 coded responses
30 check-ins
9 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 481 / MI
- Registered
- 2021-03-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-19
Registered in v-safe
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2021-03-19
Dose 1 — Janssen/Johnson & Johnson
- 2021-03-19
- 2021-03-20
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2021-03-21
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Nausea, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-03-22
Survey response — days 1–6 daily, dose 1MedDRA: Abdominal pain upper, COVID-19, Nausea, Sjogren's syndrome — Feeling: GoodFree text: My nausea and stomach pain from yesterday is gone. I would like to add for your records that I had covid19 in June and July 2020. In addition i have the autoimmune condition Sjogren's. I appreciate this vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-23
Survey response — days 1–6 daily, dose 1MedDRA: Nausea, Pain — Feeling: Fair · Abdominal painFree text: strange. pain in same right side starting at same 2:48 pm time with some nauseaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-24
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Fever · Muscle or body aches, Abdominal painAdult check-in
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2021-03-25
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain, Pyrexia — Feeling: Good · Muscle or body achesFree text: it is just the injection site area where muscle is still sore. The fever i had most of yesterday afternoon and evening is gone.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-26
- 2021-04-02
- 2021-04-09
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2021-04-16
Survey response — day 28, single doseMedDRA: Abdominal discomfort, Asthenia, Body temperature increased, Fatigue, Headache, Injection site pain, Musculoskeletal discomfort, Myalgia — Feeling: Poor · Be unable to do your normal daily activitiesFree text: muscle aches, continued soreness of vaccinated arm, intermittent slightly elevated temp, headaches, neck and abdomen discomfort, tired, low energyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Survey response — day 35, single doseMedDRA: Headache, Office visit, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: more pain in upper left arm that was vaccinated. Headaches on same side. yesterday dr ordered blood tests and CT/ultrasound for both head and arm. Completed today. tests do not show evidence of blood clot. · Healthcare visit (other): Primary care dr. 2 hospitals and lab for testsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Report sent to call center — day 35, single doseGet care from a doctor or other healthcare professional1 call case(s)
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2021-04-30
Survey response — day 42, single doseMedDRA: Office visit, Pain in extremity, Peripheral swelling, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Last week week on Thursday, April 22, my primary care dr sent me for blood work and 2 ultrasounds on Friday because of continued pain and some swelling in the arm i received the vaccination in. No blood clots were found. · Healthcare visit (other): primary care plusMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-30
Report sent to call center — day 42, single doseGet care from a doctor or other healthcare professional1 call case(s)
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2021-05-25
Call successfulCompleted over the phone
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2021-06-18
Survey response — 3 months, dose 1MedDRA: Body temperature increased, Dehydration, Dizziness, Pain in extremity, Peripheral swelling — Feeling: Good · Be unable to do your normal daily activitiesFree text: April 22 - arm pain and swelling after vaccination. sent for tests. better first werk in june.May 20- extreme heat collapse??? dizzy, dehydrated, about to faint. temp shot up to 101. used cold compresses, gatorade, rest. lasted 2 daysMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-09-17
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2021-11-18
Dose 2 — Moderna
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2022-03-21
Survey response — 12 months, dose 1MedDRA: COVID-19, Pre-existing disease, Unevaluable event — 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 visitFree text: Symptoms: Headaches. Weaker upper body. Positive covid June 23 2020. Physical therapy. JandJ vaccine March 19 2021. Moderna booster Nov 18 2021. Covid positive again Dec 22 2021. Followed with antibody infusion. · Healthcare visit (other): antibody infusionMedDRA releases: 2024-11 · check-in free text available
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2022-03-21
Report sent to call center — 12 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-03-22
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2022-03-24
Call successfulParticipant prefers to complete VAERS report online
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2022-10-17
Dose 3 — Moderna
- 2022-10-17
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2022-10-18
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-10-19
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-10-20
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2022-10-21
Survey response — days 1–6 daily, dose 3MedDRA: Asthenia, Dizziness — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: dizzy, weakMedDRA releases: 2024-11 · check-in free text available
- 2022-10-22
- 2022-10-23
- 2022-10-24
- 2022-10-31
- 2022-11-07
- 2022-11-14
- 2022-11-21
- 2022-11-28
- 2023-04-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-19 | Janssen/Johnson & Johnson | |
| 2 | 2021-11-18 | Moderna | No |
| 3 | 2022-10-17 | Moderna | No |
Call center
3 call center cases
3 successful
VAERS report filed, before or during a call: 2
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): My nausea and stomach pain from yesterday is gone. I would like to add for your records that I had covid19 in June and July 2020. In addition i have the autoimmune condition Sjogren's. I appreciate this vaccine.
Systemic reaction (other): strange. pain in same right side starting at same 2:48 pm time with some nausea
Systemic reaction (other): it is just the injection site area where muscle is still sore. The fever i had most of yesterday afternoon and evening is gone.
Release 7 — day 28, single dose
Symptoms: muscle aches, continued soreness of vaccinated arm, intermittent slightly elevated temp, headaches, neck and abdomen discomfort, tired, low energy
Release 7 — day 35, single dose
Symptoms: more pain in upper left arm that was vaccinated. Headaches on same side. yesterday dr ordered blood tests and CT/ultrasound for both head and arm. Completed today. tests do not show evidence of blood clot.
Healthcare visit (other): Primary care dr. 2 hospitals and lab for tests
Release 8 — day 42, single dose
Symptoms: Last week week on Thursday, April 22, my primary care dr sent me for blood work and 2 ultrasounds on Friday because of continued pain and some swelling in the arm i received the vaccination in. No blood clots were found.
Healthcare visit (other): primary care plus
Release 9 — 3 months, dose 1
Symptoms: April 22 - arm pain and swelling after vaccination. sent for tests. better first werk in june.May 20- extreme heat collapse??? dizzy, dehydrated, about to faint. temp shot up to 101. used cold compresses, gatorade, rest. lasted 2 days
Release 11 — 12 months, dose 1
Symptoms: Headaches. Weaker upper body. Positive covid June 23 2020. Physical therapy. JandJ vaccine March 19 2021. Moderna booster Nov 18 2021. Covid positive again Dec 22 2021. Followed with antibody infusion.
Healthcare visit (other): antibody infusion
Release 12 — days 1–6 daily, dose 3
Systemic reaction (other): dizzy, weak
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 | Abdominal discomfort | ✓ | ✓ | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Body temperature increased | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Dehydration | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Musculoskeletal discomfort | ✓ | ✓ | ✓ |
| SD | Myalgia | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Peripheral swelling | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Unevaluable event | ○ | ✓ | ○ |
| SRO | Abdominal pain upper | ✓ | ✓ | ✓ |
| SRO | Asthenia | · | · | ✓ |
| SRO | COVID-19 | ✓ | ✓ | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Nausea | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Sjogren's syndrome | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release