6T6-33468-68693

5 vaccinations 23 coded responses 66 check-ins 22 free-text entries 5 call cases

Sex: —
Age at first dose: 66+
ZIP prefix: 900 / CA
Registered: 2021-01-27

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

2021-01-27
Registered in v-safe
2021-01-27
Dose 1 — Moderna
2021-01-27
Survey response — day 0, dose 1
MedDRA: Feeling hot, Flushing, Joint swelling — Feeling: Good

Free text: slight flushed face, feel warm, slight ankle swelliing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-03
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Oropharyngeal pain — Feeling: Fair · Site: Pain, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: mild earache and sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Medical counselling, Oropharyngeal pain — Feeling: Poor · Site: Pain, Redness, 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, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): earache, sore throat · Healthcare visit (other): Spoke with pharmacist, contacted my doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Report sent to call center — days 1–6 daily, 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)
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Joint pains, Fatigue or tiredness

Free text: Fever lasted till late day yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Site: Pain, Redness, Swelling, Itching

Free text: I do have Sjogren"s and a very strong immune system. That may have had something to do with the strong reaction I had in total and it's durztion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Hypoaesthesia oral, Paraesthesia oral — Feeling: Good · Site: Pain, Redness, Swelling, Itching

Free text: Forgot to report yesterday about tingling and numbness of tongue ; has resolved

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Chills

Adult check-in
2021-03-04
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-03-11
Survey response — day 14, dose 2
MedDRA: Abdominal pain upper, Diarrhoea, Pruritus, Skin discolouration — Feeling: Good

Free text: stomache ache and loose stools. Still some arm discoloration and minot itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 28, dose 2
MedDRA: Chills, Fatigue, Headache — Feeling: Fair

Free text: Headache and.chills for several hours todzy along with fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 35, dose 2
MedDRA: Hypersensitivity, Injection site erythema, Injection site pruritus, Injection site swelling — Feeling: Good

Free text: Area below injection site where I had had Covid Arm became red again and itchy for a couple days. Has cleared up but still a slightly swollen area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Immunisation reaction, Limb mass — Feeling: Good

Free text: Lump where covid arm was.Some joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-26
Survey response — 6 months, dose 2
MedDRA: Immunisation reaction, Weight increased — Feeling: Good

Free text: gained weight for first time in life; strong reaction to Shingrex vaccination that lasted o er s week

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-29
Dose 3 — Moderna
2021-10-29
Survey response — day 0, dose 3
MedDRA: Joint swelling — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains

Free text: swollen ankles

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Muscle or body aches, Nausea, Diarrhea

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-11-04
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site pruritus, Injection site swelling, Joint swelling, Pruritus — Feeling: Good · Site: Swelling, Itching

Free text: The swelling, itch, and other arm symptoms are below the inj site to elbow

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 42, dose 3
MedDRA: Arthralgia, Pre-existing disease — Feeling: Good

Free text: joint pains hzve returned probzbly due to sjogrens. Had abated after second vax

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Call 1 — Left Voicemail
2022-01-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-01-28
Survey response — 3 months, dose 3
MedDRA: Arthralgia, Hypersensitivity, Pre-existing disease — Feeling: Fair

Free text: Knee pain, wrist pain in zddition to prior joint pains. In reased alergies.

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-02
Dose 4 — Moderna
2022-05-02
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-05-03
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2022-05-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2022-05-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2022-05-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2022-05-09
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2022-05-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-24
Survey response — day 21, dose 4
MedDRA: Granuloma annulare, Nodule, Office visit, Pre-existing disease, Pulmonary fibrosis, Pulmonary mass, Vaginal haemorrhage — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Vaginal bleeding, Granula Annulare, Node on left lung base, nodes and scarring in upper right lung, vaginal node...appeared between second vaccine and lztest booster... not sure related since also have Sjogrens · Healthcare visit (other): caught on CT Scans, gyn visit, derm visit and PC visits

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-24
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-30
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-06
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-13
Survey response — day 42, dose 4
MedDRA: Abdominal discomfort, Arthralgia, Body temperature increased, Fatigue, Headache, Hypersomnia, Nasal congestion — Feeling: Good · Be unable to do your normal daily activities

Free text: Stuffy nose, headache, fatigue, intestinal upset, joint pains and slightly elevated temp. Slept on and off for 11 hours and gone. Okay since.

MedDRA releases: 2024-11 · check-in free text available
2022-08-01
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-31
Survey response — 6 months, dose 4
MedDRA: Fatigue, Granuloma, Hysterectomy, Neoplasm malignant, Pulmonary fibrosis, Pulmonary granuloma, Pulmonary mass, Pulmonary resection, Skin cancer — 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, Hospitalization

Free text: Have just had total hysterectomy for cancer, lung resection that turned put to be necrotizing granuloma, scarring and nodules in lung, two other granulomas on thigh , severe fatigue, and other things plus a skin cancer

MedDRA releases: 2024-11 · check-in free text available
2022-10-31
Report sent to call center — 6 months, dose 4
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 · 1 call case(s)
2022-11-02
Call 1 — Could Not Reach Participant
2022-11-04
Dose 5 — Moderna
2022-11-04
Health check-in — day 0, dose 5
Feeling: Good · None

Adult check-in
2022-11-05
Survey response — days 1–6 daily, dose 5
MedDRA: Erythema, Injection site swelling — Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: mild redness on cheek and nose, swelling on upper arm below injection site

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Survey response — days 1–6 daily, dose 5
MedDRA: Nasal congestion, Oropharyngeal pain — Feeling: Good · Site: Pain, Redness, Swelling

Free text: Forgot to report sore throat and stuffy nose first two days

MedDRA releases: 2024-11 · check-in free text available
2022-11-07
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2022-11-07
Call 2 — Left Voicemail
2022-11-07
Call successful
Participant prefers to complete VAERS report online
2022-11-08
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2022-11-09
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-11-10
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Itching · Joint pains

Adult check-in
2022-11-11
Health check-in — day 7, dose 5
Feeling: Good · Site: Itching · Joint pains

Adult check-in
2022-11-18
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-26
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-12-02
Survey response — day 28, dose 5
MedDRA: Arthralgia, Back pain, Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Joint pains in fingers, knees back; fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-12-10
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-12-16
Survey response — day 42, dose 5
MedDRA: Dizziness, Dizziness postural, Granuloma, Hypotension, Immune system disorder, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Dizziness when standing up due to low BP. Received results of granulomas on thigh. Both necrotizing and appear to be same as one removed from lung. No infection, fungii or bacteria cause found. Appear to be result of immune system response.

MedDRA releases: 2024-11 · check-in free text available
2022-12-16
Report sent to call center — day 42, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-05
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-05-08
Survey response — 6 months, dose 5
MedDRA: Arthritis, Condition aggravated, Hypersensitivity, Office visit, Pre-existing disease, SARS-CoV-2 antibody test negative — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-08
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2023-05-08
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-27	Moderna
2	2021-02-25	Moderna
3	2021-10-29	Moderna	No
4	2022-05-02	Moderna	No
5	2022-11-04	Moderna	No

Call center

5 call center cases

5 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — day 0, dose 1

2021-01-27

Systemic reaction (other): slight flushed face, feel warm, slight ankle swelliing

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): mild earache and sore throat

2021-02-27

Systemic reaction (other): earache, sore throat

Healthcare visit (other): Spoke with pharmacist, contacted my doctor

2021-02-28

Systemic reaction (other): Fever lasted till late day yesterday

2021-03-01

Systemic reaction (other): I do have Sjogren"s and a very strong immune system. That may have had something to do with the strong reaction I had in total and it's durztion

2021-03-02

Systemic reaction (other): Forgot to report yesterday about tingling and numbness of tongue ; has resolved

Release 5 — day 14, dose 2

2021-03-11

Symptoms: stomache ache and loose stools. Still some arm discoloration and minot itching

Release 6 — day 28, dose 2

2021-03-25

Symptoms: Headache and.chills for several hours todzy along with fatigue.

Release 6 — day 35, dose 2

2021-04-01

Symptoms: Area below injection site where I had had Covid Arm became red again and itchy for a couple days. Has cleared up but still a slightly swollen area.

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: Lump where covid arm was.Some joint pain

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: gained weight for first time in life; strong reaction to Shingrex vaccination that lasted o er s week

Release 10 — day 0, dose 3

2021-10-29

Systemic reaction (other): swollen ankles

Release 10 — days 1–6 daily, dose 3

2021-11-04

Systemic reaction (other): The swelling, itch, and other arm symptoms are below the inj site to elbow

Release 10 — day 42, dose 3

2021-12-10

Symptoms: joint pains hzve returned probzbly due to sjogrens. Had abated after second vax

Release 11 — 3 months, dose 3

2022-01-28

Symptoms: Knee pain, wrist pain in zddition to prior joint pains. In reased alergies.

Release 11 — day 21, dose 4

2022-05-24

Symptoms: Vaginal bleeding, Granula Annulare, Node on left lung base, nodes and scarring in upper right lung, vaginal node...appeared between second vaccine and lztest booster... not sure related since also have Sjogrens

Healthcare visit (other): caught on CT Scans, gyn visit, derm visit and PC visits

Release 12 — day 42, dose 4

2022-06-13

Symptoms: Stuffy nose, headache, fatigue, intestinal upset, joint pains and slightly elevated temp. Slept on and off for 11 hours and gone. Okay since.

Release 12 — 6 months, dose 4

2022-10-31

Symptoms: Have just had total hysterectomy for cancer, lung resection that turned put to be necrotizing granuloma, scarring and nodules in lung, two other granulomas on thigh , severe fatigue, and other things plus a skin cancer

Release 12 — days 1–6 daily, dose 5

2022-11-05

Systemic reaction (other): mild redness on cheek and nose, swelling on upper arm below injection site

2022-11-06

Systemic reaction (other): Forgot to report sore throat and stuffy nose first two days

Release 12 — day 28, dose 5

2022-12-02

Symptoms: Joint pains in fingers, knees back; fatigue

Release 12 — day 42, dose 5

2022-12-16

Symptoms: Dizziness when standing up due to low BP. Received results of granulomas on thigh. Both necrotizing and appear to be same as one removed from lung. No infection, fungii or bacteria cause found. Appear to be result of immune system response.

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	·	·	✓
SD	Abdominal discomfort	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Arthritis	·	·	✓
SD	Back pain	·	·	✓
SD	Body temperature increased	·	·	✓
SD	Chills	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Dizziness postural	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Granuloma	·	·	✓
SD	Granuloma annulare	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Hypersomnia	·	·	✓
SD	Hypotension	·	·	✓
SD	Hysterectomy	·	·	✓
SD	Immune system disorder	·	·	✓
SD	Immunisation reaction	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Limb mass	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Neoplasm malignant	·	·	✓
SD	Nodule	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Pulmonary fibrosis	·	·	✓
SD	Pulmonary granuloma	·	·	✓
SD	Pulmonary mass	·	·	✓
SD	Pulmonary resection	·	·	✓
SD	SARS-CoV-2 antibody test negative	·	·	✓
SD	Skin cancer	·	·	✓
SD	Skin discolouration	✓	✓	✓
SD	Vaginal haemorrhage	·	·	✓
SD	Weight increased	✓	·	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Erythema	·	·	✓
SRO	Feeling hot	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Hypoaesthesia oral	✓	✓	✓
SRO	Injection site pruritus	·	·	✓
SRO	Injection site swelling	·	·	✓
SRO	Joint swelling	✓	✓	✓
SRO	Nasal congestion	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	·	·	✓
SRO	Pyrexia	✓	✓	✓

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