69H-86391-76544

3 vaccinations 9 coded responses 28 check-ins 9 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 775 / TX
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-04
Dose 1 — Moderna
2021-02-04
Health check-in — day 0, dose 1
Feeling: Fair · Nausea

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Redness · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Autoimmune disorder — Feeling: Good · Joint pains

Free text: Joint pain due to autoimmune disease

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Autoimmune disorder, Pre-existing disease — Feeling: Good · Joint pains

Free text: Joint pain associated with an AI disease possible flare due to getting the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Free text: Possibly AI flare and possibly Gastroparesis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — day 7, dose 1
MedDRA: Autoimmune disorder, Pre-existing disease — Feeling: Fair · Joint pains, Abdominal pain

Free text: Still not sure if related to AI disease or the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-04
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Autoimmune disorder — Feeling: Good · Joint pains, Abdominal pain

Free text: These are autoimmune related symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Survey response — day 14, dose 2
MedDRA: Carbohydrate metabolism disorder, Glucose tolerance impaired, Metabolic disorder — Feeling: Poor · Be unable to do your normal daily activities

Free text: I am not sure it is vaccine related, but I have been unable to breakdown sugars and carbohydrates since the 1rst shot and now am on antibiotics, and Sucraid and a very restrictive diet. The side effects are unbearable.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-02
Dose 3 — Pfizer-BioNTech
2021-09-03
Survey response — 6 months, dose 2
MedDRA: Intervertebral disc operation, Myasthenia gravis, Pre-existing disease, Surgery, Therapeutic nerve ablation — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: Myaesthenia Gravis exasperation, knee nerve ablation, no Covid antibodies, Cervical spine disc repair · Healthcare visit (other): Day surgery

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-08
Call 1 — Could Not Reach Participant
2021-09-13
Callback requested for
AM
2021-11-01
Survey response — 3 months, dose 3
MedDRA: Intervertebral disc protrusion, Office visit, Pain — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Herniated discs in lower back · Healthcare visit (other): Pain mgmt, Neurologist, MRI

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-21
Call 1 — Could Not Reach Participant
2021-12-28
Call 2 — Could Not Reach Participant
2022-01-31
Survey response — 6 months, dose 3
MedDRA: Intervertebral disc protrusion, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Herniated discs that will require surgery · Healthcare visit (other): In office visit

MedDRA releases: 2024-11 · check-in free text available
2022-01-31
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-02
Call 1 — Could Not Reach Participant
2022-02-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-08-02
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2021-08-02	Pfizer-BioNTech	No

Call center

3 call center cases

1 successful · 2 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-08

Systemic reaction (other): Joint pain due to autoimmune disease

2021-02-09

Systemic reaction (other): Joint pain associated with an AI disease possible flare due to getting the vaccine.

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Possibly AI flare and possibly Gastroparesis

Release 4 — day 7, dose 1

2021-02-11

Systemic reaction (other): Still not sure if related to AI disease or the vaccine.

Release 5 — days 1–6 daily, dose 2

2021-03-10

Systemic reaction (other): These are autoimmune related symptoms

Release 6 — day 14, dose 2

2021-03-19

Symptoms: I am not sure it is vaccine related, but I have been unable to breakdown sugars and carbohydrates since the 1rst shot and now am on antibiotics, and Sucraid and a very restrictive diet. The side effects are unbearable.

Release 9 — 6 months, dose 2

2021-09-03

Symptoms: Myaesthenia Gravis exasperation, knee nerve ablation, no Covid antibodies, Cervical spine disc repair

Healthcare visit (other): Day surgery

Release 10 — 3 months, dose 3

2021-11-01

Symptoms: Herniated discs in lower back

Healthcare visit (other): Pain mgmt, Neurologist, MRI

Release 11 — 6 months, dose 3

2022-01-31

Symptoms: Herniated discs that will require surgery

Healthcare visit (other): In office visit

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	Pain	·	·	✓
HCVO	Surgery	✓	·	✓
SD	Carbohydrate metabolism disorder	✓	✓	✓
SD	Glucose tolerance impaired	○	✓	○
SD	Intervertebral disc operation	✓	·	✓
SD	Intervertebral disc protrusion	·	·	✓
SD	Metabolic disorder	✓	·	✓
SD	Myasthenia gravis	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Therapeutic nerve ablation	✓	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Autoimmune disorder	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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