58Q-17375-51882

3 vaccinations 9 coded responses 16 check-ins 9 free-text entries 5 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 180 / PA
Registered: 2021-02-19

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-01-19
Dose 1 — Moderna
2021-02-19
Registered in v-safe
2021-02-19
Dose 2 — Moderna
2021-02-19
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Insomnia for 3 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Survey response — day 7, dose 2
MedDRA: Contusion, Haemorrhage — Feeling: Fair · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Bruising on hands and leg, pinpoint bruising on belly, some bleeding

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-08-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-19
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-02-22
Dose 3 — Moderna
2022-02-22
Survey response — day 0, dose 3
MedDRA: Glossodynia, Hypoaesthesia — Feeling: Poor · Site: Pain, Swelling · Joint pains, Muscle or body aches, Nausea, Abdominal pain

Free text: Tongue pain and face numbness

MedDRA releases: 2024-11 · check-in free text available
2022-02-23
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-02-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-02-26
Survey response — days 1–6 daily, dose 3
MedDRA: Eye haemorrhage, Vascular pain, Vascular rupture — Feeling: Poor · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: The blood vessel next to my right eye and across my temple is breaking. Extremely painful

MedDRA releases: 2024-11 · check-in free text available
2022-02-27
Survey response — days 1–6 daily, dose 3
MedDRA: Office visit, Vascular pain, Vascular rupture — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Blood vessels on skull breaking and hurting. Near my eye · Healthcare visit (other): Urgent care

MedDRA releases: 2024-11 · check-in free text available
2022-02-27
Report sent to call center — days 1–6 daily, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-01
Survey response — day 7, dose 3
MedDRA: Office visit, Unevaluable event — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Possibly temporal arteritis or similar issue. See vascular surgeon tomorrow · Healthcare visit (other): Rheumatologist. Vascular surgeon tomorrow

MedDRA releases: 2024-11 · check-in free text available
2022-03-01
Report sent to call center — day 7, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-03
Call 1 — Left Voicemail
2022-03-08
Survey response — day 14, dose 3
MedDRA: Unevaluable event, Vision blurred — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Worsening blurry vision. Having temporal artery biopsy done today. · Healthcare visit (other): Biopsy at hospital.

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Report sent to call center — day 14, 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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-10
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-22
Survey response — day 28, dose 3
MedDRA: Gallbladder disorder, Trigeminal neuralgia, 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

Free text: Symptoms: Diagnosed as trigeminal neuralgia. Having severe gallbladder attack now. Probably from the prednisone · Healthcare visit (other): Biopsy of temporal artery

MedDRA releases: 2024-11 · check-in free text available
2022-03-22
Report sent to call center — day 28, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-23
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-08-25
Survey response — 6 months, dose 3
MedDRA: COVID-19, Condition aggravated, Joint swelling, Pre-existing disease, Rheumatoid arthritis, Vasculitis — 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 · Outpatient clinic or urgent care clinic visit

Free text: Severe joint swelling and new onset rheumatoid arthritis. Probably from Covid I'm November, but a major flare after full dose booster. Also vasculitis. The vaccine definitely triggered worsening symptoms of autoimmune conditions.

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Report sent to call center — 6 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-08-26
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-19	Moderna
3	2022-02-22	Moderna	No

Call center

5 call center cases

4 successful · 1 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-22

Systemic reaction (other): Insomnia for 3 days.

Release 4 — day 7, dose 2

2021-02-28

Systemic reaction (other): Bruising on hands and leg, pinpoint bruising on belly, some bleeding

Release 11 — day 0, dose 3

2022-02-22

Systemic reaction (other): Tongue pain and face numbness

Release 11 — days 1–6 daily, dose 3

2022-02-26

Systemic reaction (other): The blood vessel next to my right eye and across my temple is breaking. Extremely painful

2022-02-27

Systemic reaction (other): Blood vessels on skull breaking and hurting. Near my eye

Healthcare visit (other): Urgent care

Release 11 — day 7, dose 3

2022-03-01

Systemic reaction (other): Possibly temporal arteritis or similar issue. See vascular surgeon tomorrow

Healthcare visit (other): Rheumatologist. Vascular surgeon tomorrow

Release 11 — day 14, dose 3

2022-03-08

Symptoms: Worsening blurry vision. Having temporal artery biopsy done today.

Healthcare visit (other): Biopsy at hospital.

Release 11 — day 28, dose 3

2022-03-22

Symptoms: Diagnosed as trigeminal neuralgia. Having severe gallbladder attack now. Probably from the prednisone

Healthcare visit (other): Biopsy of temporal artery

Release 12 — 6 months, dose 3

2022-08-25

Symptoms: Severe joint swelling and new onset rheumatoid arthritis. Probably from Covid I'm November, but a major flare after full dose booster. Also vasculitis. The vaccine definitely triggered worsening symptoms of autoimmune conditions.

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	Condition aggravated	·	·	✓
SD	COVID-19	·	·	✓
SD	Gallbladder disorder	·	·	✓
SD	Joint swelling	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rheumatoid arthritis	·	·	✓
SD	Trigeminal neuralgia	·	·	✓
SD	Vasculitis	·	·	✓
SD	Vision blurred	·	·	✓
SRO	Contusion	✓	✓	✓
SRO	Eye haemorrhage	·	·	✓
SRO	Glossodynia	·	·	✓
SRO	Haemorrhage	✓	✓	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Insomnia	✓	✓	✓
SRO	Unevaluable event	·	·	✓
SRO	Vascular pain	·	·	✓
SRO	Vascular rupture	·	·	✓

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