XWC-83732-93097

4 vaccinations 12 coded responses 36 check-ins 12 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 483 / MI
Registered: 2021-03-30

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

2021-03-30
Registered in v-safe
2021-03-30
Dose 1 — Janssen/Johnson & Johnson
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-06
Health check-in — 7 day, dose 1
Feeling: Fair · Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-13
Survey response — 14 day, dose 1
MedDRA: Asthenia, Cough, Diarrhoea, Fatigue, Headache, Pyrexia — Feeling: Poor · Be unable to work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-22
Survey response — 21 day, single dose
MedDRA: COVID-19, Office visit, Pneumonia, SARS-CoV-2 test negative — Feeling: Fair · 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

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-22
Report sent to call center — 21 day, single dose
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)
2021-04-27
Health check-in — 28 day, single dose
Feeling: Fair

Adult check-in
2021-05-11
Survey response — 42 day, single dose
MedDRA: Balance disorder, Pain in extremity — 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
2021-05-20
Call 1 — Left Voicemail
2021-05-20
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-06-29
Survey response — 3 month, dose 1
MedDRA: Arthralgia, Chiropractic — 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

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-06-29
Report sent to call center — 3 month, dose 1
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)
2021-07-02
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-28
Survey response — 6 month, dose 1
MedDRA: COVID-19, Food intolerance, Office visit, Pain, Vomiting — 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

MedDRA releases: 2024-11 · check-in answers available
2021-09-28
Report sent to call center — 6 month, dose 1
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 · 1 call case(s)
2021-09-29
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-23
Dose 2 — Moderna
2021-11-01
Health check-in — 7 day, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-06
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-11-13
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-11-20
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-11-27
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-12-04
Health check-in — 42 day, dose 2
Feeling: Fair

Adult check-in
2022-04-08
Dose 3 — Moderna
2022-04-25
Health check-in — 6 month, dose 2
Feeling: Fair

Adult check-in
2022-05-02
Health check-in — 21 day, dose 3
Feeling: Good

Adult check-in
2022-05-06
Survey response — 28 day, dose 3
MedDRA: Arthralgia, Headache, Pyrexia, Toothache — Feeling: Good

MedDRA releases: 2024-11 · check-in answers available
2022-05-13
Health check-in — 35 day, dose 3
Feeling: Good

Adult check-in
2022-05-22
Survey response — 42 day, dose 3
MedDRA: Headache, Oropharyngeal pain, Pyrexia — Feeling: Good · Be unable to work or attend school

MedDRA releases: 2024-11 · check-in answers available
2022-07-10
Survey response — 3 month, dose 3
MedDRA: Ageusia, Fatigue, Insomnia — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-09-19
Dose 4 — Moderna
Co-administered: Flu
2022-09-21
Survey response — days 1–6 daily, dose 4
MedDRA: Asthenia, Injection site pain — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-09-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Redness, Swelling · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2022-09-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-09-26
Health check-in — 7 day, dose 4
Feeling: Good · Site: Pain · Headache, Muscle or body aches

Adult check-in
2022-10-03
Health check-in — 14 day, dose 4
Feeling: Good

Adult check-in
2022-10-10
Survey response — 21 day, dose 4
MedDRA: Lacrimation increased, Rhinorrhoea, Sinus disorder — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-10-17
Survey response — 28 day, dose 4
MedDRA: Arthralgia, Tendon pain — Feeling: Good

MedDRA releases: 2024-11 · check-in answers available
2022-10-24
Survey response — 35 day, dose 4
MedDRA: Arthralgia — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-10-31
Health check-in — 42 day, dose 4
Feeling: Good

Adult check-in
2022-12-19
Health check-in — 3 month, dose 4
Feeling: Good

Adult check-in
2023-03-20
Health check-in — 6 month, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-30	Janssen/Johnson & Johnson
2	2021-10-23	Moderna	No
3	2022-04-08	Moderna	No
4	2022-09-19	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-04-22	Successful 2021-05-20	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-06-29	Successful 2021-07-02	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-28	Successful 2021-09-29	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 7

Symptoms: Diarrhea, fever, cough, fatigue, headache, weakness

Symptoms: Double pneumonia. Covid-19 positive.

Healthcare visit (other): Doctor's office

Release 8

Symptoms: Pain in feet and legs. Loss of balance.

Release 9

Symptoms: Shoulder pain

Healthcare visit (other): Chiropractor

Symptoms: I cannot eat solid food. This started during covid and keeps getting worse. I have pain while eating and then vomit. 5 months.

Healthcare visit (other): upper endoscopy and barium swallow. 4 in person visits to Gastroenterology doctors.

Release 11

Symptoms: Headache, slight fever, joint pain, toothache.

Symptoms: Fever, headache, sore throat.

Release 12

Symptoms: My sense of taste is returning to normal. My fatigue is still around. Not sleeping well.

Systemic reaction (other): It was worse yesterday, the first day after the booster. I didn't have anything but the injection site pain previously. Yesterday I was incapacitated I also had the flu shot in the other arm.

Symptoms: Runny nose, watering eyes, sinus issues

Symptoms: Pain in elbows and surrounding tendons.

Symptoms: Elbow pain

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	Chiropractic	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Ageusia	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Cough	✓	✓	✓
SD	COVID-19	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Food intolerance	·	·	✓
SD	Headache	✓	✓	✓
SD	Insomnia	·	·	✓
SD	Lacrimation increased	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pneumonia	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	○
SD	Sinus disorder	·	·	✓
SD	Tendon pain	·	·	✓
SD	Toothache	·	·	✓
SD	Vomiting	·	·	✓
SRO	Asthenia	·	·	✓
SRO	Injection site pain	·	·	✓

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