678-13059-71605

3 vaccinations 17 coded responses 24 check-ins 17 free-text entries 9 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 972 / OR
Registered: 2021-01-20

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-20
Registered in v-safe
2021-01-20
Dose 1 — Moderna
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising, Injection site swelling — Feeling: Good · Site: Pain, Swelling · Be unable to do your normal daily activities

Free text: Bruising (purple) at the site - along with firm raised swelling)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising — Feeling: Good · Site: Swelling · Fatigue or tiredness

Free text: Bruising at injection site (purple, not red as above)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising, Injection site swelling — Feeling: Good · Site: Swelling

Free text: Bruising at injection site (large purple area with mild swelling still)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising — Feeling: Good · Site: Swelling · Fatigue or tiredness

Free text: Bruise at injection site (purple) still

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — day 7, dose 1
MedDRA: Injection site bruising, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Bruise at injection site. Pain elsewhere - started within 1-2days of vaccine but likely unrelated so didnt then.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Survey response — day 14, dose 1
MedDRA: Emergency care, General symptom, Pain, Reaction to preservatives — Feeling: Good · 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, Emergency room or emergency department visit

Free text: Symptoms: Reaction to allergy shot over a week after vaccine - had been in maintenance dose and have to back down. Separate pain that Id had since 1-2 days after shot that is not likely linked, just in timing. · Healthcare visit (other): ER visit was a few days after the shot but I couldnt note it in daily check-in. I also could never document symptoms the day if the shit when I was watched fir longer by medical staff (right after shot). This program didnt work that day (could not register till day after).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
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)
2021-02-10
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-18
Dose 2 — Moderna
2021-02-18
Survey response — day 0, dose 2
MedDRA: Dizziness, Hypertension, Medical observation — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Fatigue or tiredness · Be unable to work, 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): Significant lightheadedness and funny sensations in my head, ears and throat -, had to be watched again like first time, and they asked me to get a ride home again. Had unusually high BP too. This is very abnormal for me and I get so many immunizations as a health care provider · Healthcare visit (other): Observation area at vaccine site staffed with ED folks to keep an eye on us

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Report sent to call center — day 0, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure increased, Dizziness — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Elevated BP like after the shot in observation area - strange! And lightheartedness, feeling faint, couldnt do things like walk the dog like normal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure increased, Dizziness — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Still lightheaded/dizzy... and BP still elevated abnormal for me

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-25
Survey response — day 7, dose 2
MedDRA: Emergency care, Rectal abscess — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Rectal abscess which started within 1-2 days of last vaccine is again a problem. Never had before. Maybe its linked to vaccine??? Worse the last couple days, went to ER last night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Report sent to call center — day 7, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Survey response — day 14, dose 2
MedDRA: Abscess, Adverse reaction, Emergency care, Immediate post-injection reaction, Office visit — Feeling: Good · Be unable to work, 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, Emergency room or emergency department visit

Free text: Symptoms: Abscess starting after 1st vaccine - no one has called to discuss this or other (e.g., reactions starting 10- 15 minutes after vaccine) · Healthcare visit (other): Surgical consult following ED visit 1 week ago

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 14, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-18
Survey response — day 28, dose 2
MedDRA: Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headache and fatigue - seems to be lasting several days - may be completely unrelated. No other symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 35, dose 2
MedDRA: Diarrhoea, Haemorrhage, Proctalgia, Rectal abscess — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Recurrence of symptoms that started a couple days after the first vaccine - thought all was done, unclear if linked or not but never ever had before. Had rectal abscess that cleared up but same acute rectal pain and now diarrhea with some bleeding.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-20
Survey response — 3 months, dose 2
MedDRA: Blood pressure increased, Condition aggravated, Dizziness, Immediate post-injection reaction, Pre-existing disease, Swollen tongue, Throat tightness, Vaccine positive rechallenge — Feeling: Good · 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: Sustained high BP - really since the 1st vaccine. Was high after each vaccine when I started to feel suddenly lightheaded about 15 minutes after both shots + throat/tongue fulIness. have a h/o low BP, at times too low. Really high now-often 160/100+

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-22
Call 1 — Requested Callback
2021-07-01
Call 2 — Left Voicemail
2021-07-01
Callback requested for
03:30PM ET
2021-08-21
Survey response — 6 months, dose 2
MedDRA: Blood pressure increased, COVID-19, Chest pain, Electrolyte imbalance, Emergency care, Heart rate increased, Illness, Office visit — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Intermittent chest pains, increased BP & HR (never had these before all of this). Had funky electrolytes once when sent by PCP to ER, for no clear reason since ate well. Have not had Echo - not sure theyll ever order. Recent illness, -covid.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-21
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 1 — Left Voicemail
2021-11-17
Dose 3 — Pfizer-BioNTech
2022-02-18
Survey response — 12 months, dose 2
MedDRA: Depression, Hyperthyroidism, Pre-existing disease, Thyroiditis — Feeling: Good · 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, Emergency room or emergency department visit, Hospitalization

Free text: Hyperthyroidism or Thyroiditis - still in follow-up. This in top of depression which is worse since all of this Other things but can't recall when you last contacted me

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-22
Call 1 — Left Voicemail
2022-11-19
Survey response — 12 months, dose 3
MedDRA: Arrhythmia, Cognitive disorder, Depressed mood, Illness, Thyroid disorder, Unevaluable event, Viral infection — Feeling: Good · 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, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Tori'thyroid stuff and raoud Pulse occasional arrhythmia but not as bad as last year all started after virus in 11/2020 that can't confirm if was COVID or not. Also still with cognitive stuff and mood down ever since that illness. Did have symptoms a · Healthcare visit (other): I can't remember last church in but it it was last year then trees do it have all these not necessarily if more recent

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Report sent to call center — 12 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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-11-21
Call 1 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail
2022-11-21
Call 3 — Left Voicemail
2022-11-21
Call 2 — Left Voicemail
2022-11-21
Call 2 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-18	Moderna
3	2021-11-17	Pfizer-BioNTech	No

Call center

9 call center cases

9 unsuccessful

5 waits over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-21

Systemic reaction (other): Bruising (purple) at the site - along with firm raised swelling)

2021-01-23

Systemic reaction (other): Bruising at injection site (purple, not red as above)

2021-01-24

Systemic reaction (other): Bruising at injection site (large purple area with mild swelling still)

2021-01-25

Systemic reaction (other): Bruise at injection site (purple) still

Release 2 — day 7, dose 1

2021-01-27

Systemic reaction (other): Bruise at injection site. Pain elsewhere - started within 1-2days of vaccine but likely unrelated so didnt then.

Release 3 — day 14, dose 1

2021-02-03

Symptoms: Reaction to allergy shot over a week after vaccine - had been in maintenance dose and have to back down. Separate pain that Id had since 1-2 days after shot that is not likely linked, just in timing.

Healthcare visit (other): ER visit was a few days after the shot but I couldnt note it in daily check-in. I also could never document symptoms the day if the shit when I was watched fir longer by medical staff (right after shot). This program didnt work that day (could not register till day after).

Release 4 — day 0, dose 2

2021-02-18

Systemic reaction (other): Significant lightheadedness and funny sensations in my head, ears and throat -, had to be watched again like first time, and they asked me to get a ride home again. Had unusually high BP too. This is very abnormal for me and I get so many immunizations as a health care provider

Healthcare visit (other): Observation area at vaccine site staffed with ED folks to keep an eye on us

Release 4 — days 1–6 daily, dose 2

2021-02-19

Systemic reaction (other): Elevated BP like after the shot in observation area - strange! And lightheartedness, feeling faint, couldnt do things like walk the dog like normal

2021-02-20

Systemic reaction (other): Still lightheaded/dizzy... and BP still elevated abnormal for me

Release 4 — day 7, dose 2

2021-02-25

Systemic reaction (other): Rectal abscess which started within 1-2 days of last vaccine is again a problem. Never had before. Maybe its linked to vaccine??? Worse the last couple days, went to ER last night

Release 5 — day 14, dose 2

2021-03-04

Symptoms: Abscess starting after 1st vaccine - no one has called to discuss this or other (e.g., reactions starting 10- 15 minutes after vaccine)

Healthcare visit (other): Surgical consult following ED visit 1 week ago

Release 5 — day 28, dose 2

2021-03-18

Symptoms: Headache and fatigue - seems to be lasting several days - may be completely unrelated. No other symptoms

Release 6 — day 35, dose 2

2021-03-25

Symptoms: Recurrence of symptoms that started a couple days after the first vaccine - thought all was done, unclear if linked or not but never ever had before. Had rectal abscess that cleared up but same acute rectal pain and now diarrhea with some bleeding. cut off by CDC

Release 8 — 3 months, dose 2

2021-05-20

Symptoms: Sustained high BP - really since the 1st vaccine. Was high after each vaccine when I started to feel suddenly lightheaded about 15 minutes after both shots + throat/tongue fulIness. have a h/o low BP, at times too low. Really high now-often 160/100+ cut off by CDC

Release 9 — 6 months, dose 2

2021-08-21

Symptoms: Intermittent chest pains, increased BP & HR (never had these before all of this). Had funky electrolytes once when sent by PCP to ER, for no clear reason since ate well. Have not had Echo - not sure theyll ever order. Recent illness, -covid.

Release 11 — 12 months, dose 2

2022-02-18

Symptoms: Hyperthyroidism or Thyroiditis - still in follow-up. This in top of depression which is worse since all of this Other things but can't recall when you last contacted me

Release 12 — 12 months, dose 3

2022-11-19

Symptoms: Tori'thyroid stuff and raoud Pulse occasional arrhythmia but not as bad as last year all started after virus in 11/2020 that can't confirm if was COVID or not. Also still with cognitive stuff and mood down ever since that illness. Did have symptoms a cut off by CDC

Healthcare visit (other): I can't remember last church in but it it was last year then trees do it have all these not necessarily if more recent

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	Emergency care	✓	✓	✓
HCVO	General symptom	✓	✓	✓
HCVO	Medical observation	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Abscess	✓	✓	✓
SD	Adverse reaction	✓	✓	✓
SD	Arrhythmia	·	·	✓
SD	Blood pressure increased	✓	✓	✓
SD	Chest pain	✓	·	✓
SD	Cognitive disorder	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	COVID-19	✓	·	✓
SD	Depressed mood	·	·	✓
SD	Depression	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Electrolyte imbalance	✓	·	✓
SD	Emergency care	✓	·	✓
SD	Fatigue	✓	✓	✓
SD	Haemorrhage	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	✓	·	✓
SD	Hyperthyroidism	·	·	✓
SD	Illness	✓	·	✓
SD	Immediate post-injection reaction	✓	✓	✓
SD	Office visit	✓	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Proctalgia	✓	✓	✓
SD	Reaction to preservatives	✓	✓	✓
SD	Rectal abscess	✓	✓	✓
SD	Swollen tongue	✓	✓	✓
SD	Throat tightness	✓	✓	✓
SD	Thyroid disorder	·	·	✓
SD	Thyroiditis	·	·	✓
SD	Vaccine positive rechallenge	✓	✓	✓
SD	Viral infection	·	·	✓
SRO	Blood pressure increased	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Medical observation	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Rectal abscess	✓	✓	✓

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