XX8-26351-45737

2 vaccinations 18 coded responses 23 check-ins 17 free-text entries 8 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 144 / NY
Registered: 2021-04-05

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-03
Dose 1 — Janssen/Johnson & Johnson
2021-04-05
Registered in v-safe
2021-04-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dry mouth, Oropharyngeal pain — Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dry mouth, Malaise — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-07
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Dyspnoea — Feeling: Poor · Chills, Nausea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-08
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Dyspnoea — Feeling: Poor · Chills · Be unable to do your normal daily activities

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

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-10
Survey response — 7 day, dose 1
MedDRA: Cough, Dyspnoea — Feeling: Poor · 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 — 14 day, dose 1
MedDRA: Chest discomfort, Fibrin D dimer increased, Immunisation reaction, Office visit — Feeling: Poor · Be unable to work, 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

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-17
Report sent to call center — 14 day, dose 1
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)
2021-04-24
Health check-in — 21 day, single dose
Feeling: Fair

Adult check-in
2021-05-01
Health check-in — 28 day, single dose
Feeling: Fair

Adult check-in
2021-05-08
Survey response — 35 day, single dose
MedDRA: Arthralgia, Rheumatoid factor positive — Feeling: Fair · 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
2021-05-08
Report sent to call center — 35 day, single dose
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-15
Survey response — 42 day, single dose
MedDRA: Arthralgia, Discomfort, Emergency care, Inflammation — Feeling: Poor · 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, Emergency room or emergency department visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-15
Report sent to call center — 42 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)
2021-05-25
Call 2 — Left Voicemail
2021-07-03
Survey response — 3 month, dose 1
MedDRA: Connective tissue disorder, Hypersensitivity — 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: 2021-09,2023-04,2024-11 · check-in answers available
2021-07-03
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)
2021-07-08
Call 2 — Left Voicemail
2021-10-02
Survey response — 6 month, dose 1
MedDRA: Dysphagia, Hypersensitivity, Pharyngeal disorder, Pre-existing disease, Self-medication, Skin test positive — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2021-10-02
Report sent to call center — 6 month, dose 1
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-05
Call 3 — Left Voicemail
2022-03-28
Dose 2 — Pfizer-BioNTech
2022-04-04
Survey response — 12 month, dose 1
MedDRA: Dysphagia, Undifferentiated connective tissue disease — 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, Emergency room or emergency department visit

MedDRA releases: 2024-11 · check-in answers available
2022-04-04
Survey response — 7 day, dose 2
MedDRA: Chest discomfort, Chest pain — Feeling: Fair · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2024-11 · check-in answers available
2022-04-04
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-04-05
Call 2 — Left Voicemail
2022-04-11
Survey response — 14 day, dose 2
MedDRA: Arthralgia, Fatigue, Muscular weakness, Myalgia — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-04-18
Survey response — 21 day, dose 2
MedDRA: Arthralgia, Fatigue — Feeling: Fair

MedDRA releases: 2024-11 · check-in answers available
2022-04-26
Survey response — 28 day, dose 2
MedDRA: Eczema, Furuncle — Feeling: Fair

MedDRA releases: 2024-11 · check-in answers available
2022-05-02
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2022-05-09
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2022-06-29
Health check-in — 3 month, dose 2
Feeling: Fair

Adult check-in
2022-09-27
Survey response — 6 month, dose 2
MedDRA: Nephrolithiasis — 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

MedDRA releases: 2024-11 · check-in answers available
2022-09-27
Report sent to call center — 6 month, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-09-29
Call 2 — Left Voicemail
2022-09-29
Call 2 — Left Voicemail
2022-09-29
Call 3 — Left Voicemail
2022-09-29
Call 3 — Left Voicemail
2022-09-29
Call 2 — Left Voicemail
2022-09-29
Call 3 — Left Voicemail
2022-09-29
Call 2 — Left Voicemail
2023-03-30
Survey response — 12 month, dose 2
MedDRA: Palpitations, Rosacea, Tremor — 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, Emergency room or emergency department visit

MedDRA releases: 2024-11 · check-in answers available
2023-03-30
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail
2023-03-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-03	Janssen/Johnson & Johnson
2	2022-03-28	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-17	Unsuccessful
2021-05-08	Unsuccessful
2021-05-15	Unsuccessful
2021-07-03	Unsuccessful
2021-10-02	Unsuccessful
2022-04-04	Unsuccessful
2022-09-27	Unsuccessful
2023-03-30	Unsuccessful

Free text

Release 6

Systemic reaction (other): Dry mouth, sore throat

Release 7

Systemic reaction (other): Dry mouth, general malaise

Systemic reaction (other): Short of breath, coughing

Systemic reaction (other): Cough and short of breath

Systemic reaction (other): Shortness of breath and dry cough

Symptoms: Bad allergic reaction to J&J vaccine. My doctor put me on prednisone for severe chest discomfort on inhale and I had several tests at (b)(6) hospital, including blood work, EKG, X-ray and CT scan after a high d-dimer test. I still have discomfort. cut off by CDC

Healthcare visit (other): Diagnostic Imaging

redacted (b)(6)

Release 8

Symptoms: Rheumatoid factor was negative 2 months prior to vaccine and now is positive. Transient intense joint pain in fingers and toes.

Symptoms: I awoke with intense left shoulder pain Monday morning. Went to emergency, general practitioner, and orthopedic. I have inflammation that has persisted for 6 weeks now that is causing transient discomfort and am on an anti inflammatory medication.

Release 9

Symptoms: Undifferentiated connective tissue disease, new and worsening allergies

Symptoms: Allergist performed skin tests which revealed I have new and worsening allergies. I now have swilling issues where food gets stuck in my throat. After 5 months of hydroxychloriquine, most of my breathing discomfort from pleurisy has subsided.

Release 11

Symptoms: I developed swallowing issues since my last update. I have been diagnosed with UCTD.

Systemic reaction (other): Breathing discomfort and chest pain

Symptoms: Extreme fatigue, muscle soreness and weakness. Migrating arthralgia.

Symptoms: Fatigue and arthralgia

Symptoms: Boils and eczema. All other symptoms went away.

Release 12

Symptoms: Kidney stone

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	Chest discomfort	✓	✓	✓
SD	Connective tissue disorder	✓	✓	✓
SD	Discomfort	✓	✓	✓
SD	Dysphagia	·	·	✓
SD	Eczema	·	·	✓
SD	Emergency care	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Fibrin D dimer increased	✓	✓	✓
SD	Furuncle	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Inflammation	✓	✓	✓
SD	Muscular weakness	·	·	✓
SD	Myalgia	·	·	✓
SD	Nephrolithiasis	·	·	✓
SD	Palpitations	·	·	✓
SD	Pharyngeal disorder	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rheumatoid factor positive	✓	✓	✓
SD	Rosacea	·	·	✓
SD	Self-medication	·	·	✓
SD	Skin test positive	·	·	✓
SD	Tremor	·	·	✓
SD	Undifferentiated connective tissue disease	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓

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