XUF-21726-11393

2 vaccinations 13 coded responses 30 check-ins 13 free-text entries 3 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 481 / MI
Registered: 2021-04-10

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

2021-04-10
Registered in v-safe
2021-04-10
Dose 1 — Janssen/Johnson & Johnson
2021-04-10
Survey response — 0 day, dose 1
MedDRA: Visual impairment — Feeling: Good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-11
Survey response — days 1–6 daily, dose 1
MedDRA: Visual impairment — Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-16
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Fair · Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-17
Survey response — 7 day, dose 1
MedDRA: Cough — Feeling: Fair · Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-24
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-05-02
Health check-in — 21 day, single dose
Feeling: Good

Adult check-in
2021-05-08
Health check-in — 28 day, single dose
Feeling: Good

Adult check-in
2021-05-15
Health check-in — 35 day, single dose
Feeling: Good

Adult check-in
2021-05-22
Health check-in — 42 day, single dose
Feeling: Good

Adult check-in
2021-07-10
Survey response — 3 month, dose 1
MedDRA: Dizziness, Headache, Hypoaesthesia, Office visit, Paraesthesia — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-07-10
Report sent to call center — 3 month, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-14
Call 1 — Left Voicemail
2021-10-09
Health check-in — 6 month, dose 1
Feeling: Good

Adult check-in
2021-11-27
Dose 2 — Moderna
2021-11-27
Health check-in — 0 day, dose 2
Feeling: Good · Chills

Adult check-in
2021-11-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-11-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Nausea

Adult check-in
2021-12-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Nausea

Adult check-in
2021-12-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-12-04
Health check-in — 7 day, dose 2
Feeling: Poor · Joint pains, Muscle or body aches · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-11
Survey response — 14 day, dose 2
MedDRA: Back pain, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2021-12-18
Survey response — 21 day, dose 2
MedDRA: Facial pain, Headache, Neck pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2021-12-25
Survey response — 28 day, dose 2
MedDRA: Cough, Pain in extremity — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-01-01
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2022-01-10
Survey response — 42 day, dose 2
MedDRA: Arthralgia, Chills, Cough, Diarrhoea, Micturition disorder, Productive cough — 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

MedDRA releases: 2024-11 · check-in answers available
2022-01-10
Report sent to call center — 42 day, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-11
Call 1 — Left Voicemail
2022-01-12
Call successful
Does not wish to fill out VAERS report
2022-02-26
Survey response — 3 month, dose 2
MedDRA: Cholelithiasis, Dyspnoea, Pulmonary fibrosis — 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, Emergency room or emergency department visit

MedDRA releases: 2024-11 · check-in answers available
2022-02-26
Report sent to call center — 3 month, 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 · Emergency room or emergency department visit · 1 call case(s)
2022-02-28
Call 1 — Left Voicemail
2022-05-28
Health check-in — 6 month, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-10	Janssen/Johnson & Johnson
2	2021-11-27	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-10	Successful	Does not wish to fill out VAERS report
2022-01-10	Successful 2022-01-12	Does not wish to fill out VAERS report
2022-02-26	Unsuccessful

Free text

Release 7

Systemic reaction (other): Spot in vision

Systemic reaction (other): My vision problems yesterday went away couple hours after shot

Systemic reaction (other): Persistent cough

Systemic reaction (other): Cough

Systemic reaction (other): Still persistent cough

Systemic reaction (other): Persistent cough

Systemic reaction (other): Cough

Release 9

Symptoms: Numbness and tingling in fingers of right hand. Also dizziness and headaches off and on. Not sure if related to shot.

Healthcare visit (other): Doctors office

Release 10

Symptoms: Leg and back pain. Probably not due to vaccine.

Symptoms: Pains in face and neck, headache

Symptoms: Cough and leg aches

Symptoms: Cough, chills, diarrhea, lots of phlegm, urination problems, joint pain.

Release 11

Symptoms: Shortness of breath, lung scarring. Possibly due to a past covid infection. Currently diagnosed with gallstones and waiting for surgery.

Free-text releases are not linked to a specific 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	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Chills	·	·	✓
SD	Cholelithiasis	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	·	·	✓
SD	Facial pain	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Micturition disorder	·	·	✓
SD	Neck pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Paraesthesia	✓	✓	✓
SD	Productive cough	·	·	✓
SD	Pulmonary fibrosis	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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