67Z-14105-55714

3 vaccinations 7 coded responses 15 check-ins 7 free-text entries 6 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 296 / SC
Registered: 2021-01-06

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

2020-12-30
Dose 1 — Moderna
2021-01-06
Registered in v-safe
2021-01-06
Health check-in — day 7, dose 1
Feeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-13
Survey response — day 14, dose 1
MedDRA: Fatigue, Feeling abnormal, Myalgia, 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

Free text: Symptoms: Really exhausted. Myalgia. Mentally foggy. · Healthcare visit (other): ECHO cardiogram

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
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)
2021-01-27
Dose 2 — Moderna
2021-02-03
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain

Adult check-in
2021-02-12
Survey response — day 14, dose 2
MedDRA: Abdominal pain, Diarrhoea, Ear pain, Erythema, Lymphadenopathy, Medical counselling — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: GI symptoms, abdominal pain and diarrhea. Swollen lymph nodes under vaccine arm and on neck under rt jawline. Earache due to swelling in that area. Breast on right was red but now ok. · Healthcare visit (other): NP at work was consulted

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-17
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-02-24
Survey response — day 28, dose 2
MedDRA: Ear pain, Headache, Lymphadenopathy — Feeling: Poor · Be unable to do your normal daily activities

Free text: After 2nd vaccine lymph nodes under rt arm and under right jaw swelled badly. Under arm is gone. Under jaw has improved but my ear is still hurting from being swollen shut. Really painful. Today, bad headache to front of forehead/ top of head.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — day 35, dose 2
MedDRA: Dizziness, Ear pain, Ear swelling, Lymph node pain, Lymphadenopathy, Medical counselling, Nausea, Vertigo — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Cerical lymph node under rt jawline still swollen and painful. Ear swelled shut ans had to seek medical treatment due to ear pain. Antibiotic drops being used. Dizzy, vertigo and nausea. · Healthcare visit (other): NP at work

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

1 call case(s)
2021-03-04
Call 1 — Left Voicemail
2021-03-10
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-04-28
Survey response — 3 months, dose 2
MedDRA: Ear pain, Full blood count abnormal, Lymphadenopathy, Middle ear effusion, Type 2 diabetes mellitus — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diagnosed with Type 2 Diabetes with Hgb A1c of 11.3 and put on insulin. Abnormal blood count and Rt cervical lymphadenopathy. With rt ear fluid and pain. I am to return to MD mid May 2021 for another follow up related to this.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call 1 — Left Voicemail
2021-07-28
Survey response — 6 months, dose 2
MedDRA: Diabetes mellitus, Fatigue, Leukaemia, Lymphadenopathy, Office visit, Parotid gland enlargement, Pericardial effusion, Salivary gland enlargement — Feeling: Fair · 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: Symptoms: Lymph swelling in rt neck, jaw and ear pain , small pericardial effusion, Diabetes on insulin and now T cell LGL leukemia. Feel exhausted all the time.All believed to be CoVID19 or vaccine related. Seeing PCP, ENT, Cardiologist, ST and an oncologist. · Healthcare visit (other): In office vists with MDs and a ST

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-28
Report sent to call center — 6 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

1 call case(s)
2021-09-23
Dose 3 — Moderna
2021-10-24
Survey response — day 28, dose 3
MedDRA: Large granular lymphocytosis, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Diagnosed with T Cell LGL leukemia · Healthcare visit (other): Office visits

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-27
Call 1 — Left Voicemail
2021-10-28
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-04
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-12-23
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna
2	2021-01-27	Moderna
3	2021-09-23	Moderna	No

Call center

6 call center cases

6 unsuccessful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 1 — day 14, dose 1

2021-01-13

Symptoms: Really exhausted. Myalgia. Mentally foggy.

Healthcare visit (other): ECHO cardiogram

Release 4 — day 14, dose 2

2021-02-12

Symptoms: GI symptoms, abdominal pain and diarrhea. Swollen lymph nodes under vaccine arm and on neck under rt jawline. Earache due to swelling in that area. Breast on right was red but now ok.

Healthcare visit (other): NP at work was consulted

Release 4 — day 28, dose 2

2021-02-24

Symptoms: After 2nd vaccine lymph nodes under rt arm and under right jaw swelled badly. Under arm is gone. Under jaw has improved but my ear is still hurting from being swollen shut. Really painful. Today, bad headache to front of forehead/ top of head.

Release 5 — day 35, dose 2

2021-03-03

Symptoms: Cerical lymph node under rt jawline still swollen and painful. Ear swelled shut ans had to seek medical treatment due to ear pain. Antibiotic drops being used. Dizzy, vertigo and nausea.

Healthcare visit (other): NP at work

Release 8 — 3 months, dose 2

2021-04-28

Symptoms: Diagnosed with Type 2 Diabetes with Hgb A1c of 11.3 and put on insulin. Abnormal blood count and Rt cervical lymphadenopathy. With rt ear fluid and pain. I am to return to MD mid May 2021 for another follow up related to this.

Release 9 — 6 months, dose 2

2021-07-28

Symptoms: Lymph swelling in rt neck, jaw and ear pain , small pericardial effusion, Diabetes on insulin and now T cell LGL leukemia. Feel exhausted all the time.All believed to be CoVID19 or vaccine related. Seeing PCP, ENT, Cardiologist, ST and an oncologist. cut off by CDC

Healthcare visit (other): In office vists with MDs and a ST

Release 10 — day 28, dose 3

2021-10-24

Symptoms: Diagnosed with T Cell LGL leukemia

Healthcare visit (other): Office visits

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	✓	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Diabetes mellitus	✓	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Ear swelling	✓	✓	✓
SD	Erythema	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Full blood count abnormal	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Large granular lymphocytosis	·	·	✓
SD	Leukaemia	✓	·	✓
SD	Lymph node pain	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Middle ear effusion	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Office visit	✓	·	✓
SD	Parotid gland enlargement	✓	·	✓
SD	Pericardial effusion	✓	·	✓
SD	Salivary gland enlargement	✓	·	✓
SD	Type 2 diabetes mellitus	✓	✓	✓
SD	Vertigo	✓	✓	✓

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