4VT-17522-22701

2 vaccinations 17 coded responses 30 check-ins 17 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 804 / CO
Registered: 2021-07-12

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

2021-07-12
Registered in v-safe
2021-07-12
Dose 1 — Janssen/Johnson & Johnson
2021-07-12
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Swelling · None

Adult check-in
2021-07-13
Survey response — days 1–6 daily, dose 1
MedDRA: Eye swelling, Ocular discomfort, Pruritus — Feeling: Fair · Site: Pain, Itching · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Left eye swelling and discomfort, itching all over

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Survey response — days 1–6 daily, dose 1
MedDRA: Eye irritation, Eye pain, Eye swelling — Feeling: Fair · Fatigue or tiredness

Free text: Left eye still swollen better today but irritated achey

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-07-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-07-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-07-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-07-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-07-26
Survey response — day 14, dose 1
MedDRA: Cough, Rash, Rash pruritic, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rash on abdomen, left thigh, back and chest. Is now resolving but still itchy. Also have been isolated from other people but have runny nose and cough. I know I have not been exposed to covid, may be allergies?

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-02
Survey response — day 21, single dose
MedDRA: Headache, Nasal congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Frequent headaches, stuff nose for weeks now.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-09
Survey response — day 28, single dose
MedDRA: Dizziness, Dyspnoea, Headache, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Difficultly breathing headaches dizziness although air quality has been very poor. Have asthma.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Survey response — day 35, single dose
MedDRA: Cough, Dyspnoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Coughing shortness of breath but think its due to poor air quality and not vaccine or covid

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — day 35, single dose
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-23
Survey response — day 42, single dose
MedDRA: Dyspnoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-24
Call 1 — Left Voicemail
2021-10-11
Health check-in — 3 months, dose 1
Feeling: Fair

Adult check-in
2022-01-14
Survey response — 6 months, dose 1
MedDRA: Dyspnoea, Respiratory tract congestion, Rhinorrhoea — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Trouble breathing, runny nose, congestion etc. Have not been tested for covid yet hard to find a place with an open appnt. Really do not want to go into a store especially if i am positive. Hard to get timely Dr appnt either

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Dose 2 — Moderna
2022-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Injection site pain, Neck pain — Feeling: Poor · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Injection site pain that extends to shoulder and neck

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Injection site pain, Neck pain — Feeling: Poor · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Pain persists from injection site to shoulder and neck

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Injection site pain, Neck pain, Pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Still having shoulder and neck pain radiating from injection site

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Injection site pain, Neck pain, Pain — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Pain in shoulder and neck radiating from injection site

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Injection site pain, Neck pain, Pain — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Pain from injection site still radiating to shoulder and neck but milder today

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-05-07
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-05-14
Survey response — day 14, dose 2
MedDRA: Dyspnoea — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Relentless shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2022-05-21
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2022-05-28
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2022-06-04
Survey response — day 35, dose 2
MedDRA: Cough, Dyspnoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Shortness of breath, coughing

MedDRA releases: 2024-11 · check-in free text available
2022-06-13
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2022-07-30
Survey response — 3 months, dose 2
MedDRA: Dyspnoea, Fatigue, Weight decreased — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: More shortness of breathe, weight-loss, exhaustion

MedDRA releases: 2024-11 · check-in free text available
2022-10-29
Survey response — 6 months, dose 2
MedDRA: Fatigue, Muscular weakness, Tachycardia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Fatigue, muscle weakness, postural tachycardia

MedDRA releases: 2024-11 · check-in free text available
2023-04-30
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-12	Janssen/Johnson & Johnson	No
2	2022-04-30	Moderna	No

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 9 — days 1–6 daily, dose 1

2021-07-13

Systemic reaction (other): Left eye swelling and discomfort, itching all over

2021-07-14

Systemic reaction (other): Left eye still swollen better today but irritated achey

Release 9 — day 14, dose 1

2021-07-26

Symptoms: Rash on abdomen, left thigh, back and chest. Is now resolving but still itchy. Also have been isolated from other people but have runny nose and cough. I know I have not been exposed to covid, may be allergies?

Release 9 — day 21, single dose

2021-08-02

Symptoms: Frequent headaches, stuff nose for weeks now.

Release 9 — day 28, single dose

2021-08-09

Symptoms: Difficultly breathing headaches dizziness although air quality has been very poor. Have asthma.

Release 9 — day 35, single dose

2021-08-16

Symptoms: Coughing shortness of breath but think its due to poor air quality and not vaccine or covid

Release 9 — day 42, single dose

2021-08-23

Symptoms: Shortness of breath

Release 10 — 6 months, dose 1

2022-01-14

Symptoms: Trouble breathing, runny nose, congestion etc. Have not been tested for covid yet hard to find a place with an open appnt. Really do not want to go into a store especially if i am positive. Hard to get timely Dr appnt either

Release 11 — days 1–6 daily, dose 2

2022-05-01

Systemic reaction (other): Injection site pain that extends to shoulder and neck

2022-05-02

Systemic reaction (other): Pain persists from injection site to shoulder and neck

2022-05-03

Systemic reaction (other): Still having shoulder and neck pain radiating from injection site

2022-05-04

Systemic reaction (other): Pain in shoulder and neck radiating from injection site

2022-05-05

Systemic reaction (other): Pain from injection site still radiating to shoulder and neck but milder today

Release 11 — day 14, dose 2

2022-05-14

Symptoms: Relentless shortness of breath

Release 11 — day 35, dose 2

2022-06-04

Symptoms: Shortness of breath, coughing

Release 12 — 3 months, dose 2

2022-07-30

Symptoms: More shortness of breathe, weight-loss, exhaustion

Release 12 — 6 months, dose 2

2022-10-29

Symptoms: Fatigue, muscle weakness, postural tachycardia

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
SD	Cough	✓	·	✓
SD	Dizziness	✓	·	✓
SD	Dyspnoea	✓	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	·	✓
SD	Muscular weakness	·	·	✓
SD	Nasal congestion	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Rash	✓	·	✓
SD	Rash pruritic	✓	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	Tachycardia	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Eye irritation	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Injection site pain	·	·	✓
SRO	Neck pain	·	·	✓
SRO	Ocular discomfort	✓	✓	✓
SRO	Pain	·	·	✓
SRO	Pruritus	✓	✓	✓

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