YJW-93305-00434

4 vaccinations 20 coded responses 39 check-ins 19 free-text entries 6 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 105 / NY
Registered: 2021-01-11

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

2021-01-08
Dose 1 — Moderna
2021-01-11
Registered in v-safe
2021-01-11
Survey response — days 1–6 daily, dose 1
MedDRA: Glossodynia — Feeling: Good · Site: Pain, Swelling · Fever · Chills, Fatigue or tiredness

Free text: Sore tongue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Asthenia, Influenza like illness, Rhinorrhoea, Sneezing — Feeling: Fair · Fever · Fatigue or tiredness

Free text: Weak, fluish, runny nose, sneezing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain, Nasal congestion, Rhinorrhoea, Sneezing — Feeling: Fair · Fever · Chills, Fatigue or tiredness

Free text: Very Mild to no earache like sore throat maybe coming on nasal stuffiness runny nose. Occasional sneezing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-14
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-15
Survey response — day 7, dose 1
MedDRA: Pyrexia — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: A little feverish.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-01-29
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-05
Dose 2 — Moderna
2021-02-05
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Fever · Fatigue or tiredness

Free text: I just got vaccination 30 minutes ago

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Headache, Pyrexia, Tremor — Feeling: Poor · Site: Pain, Redness, Swelling · 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

Free text: Pain in head, severe shaking with fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: Feverish more mild on and off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Headache — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Fatigue or tiredness

Free text: Almost like headache, some shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-12
Survey response — day 7, dose 2
MedDRA: Injection site erythema, Injection site swelling, Pain — Feeling: Fair · Site: Redness, Swelling · Muscle or body aches, Fatigue or tiredness

Free text: Pretty significant pain in the side which I never get for 2 days. Arm still has a bump and visible redness at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-26
Survey response — day 21, dose 2
MedDRA: Colitis, Dizziness, Ear pain, Influenza like illness, Laryngitis, Nausea, Pyrexia, Rhinorrhoea — Feeling: Fair

Free text: On and off flue like symptoms: feverish, nausea, colitis like symptoms severe at times. Runny nose, dizziness, laryngitis, mild earaches, etc.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 28, dose 2
MedDRA: Fatigue, Nasal congestion, Respiratory tract congestion — Feeling: Fair

Free text: Nasal congestion, sine chest congestion. Enormous fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 35, dose 2
MedDRA: Dizziness, Dyspnoea, Eye pruritus, Fatigue, Hypersensitivity, Pre-existing disease, Rhinorrhoea — Feeling: Fair

Free text: Severe allergies after 40+ years of 6 allergy shots a week. Its like covid shots reversed allergy shots. Runny nose, itchy eyes, short of breath, dizzy, severe exhaustion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 42, dose 2
MedDRA: Dyspnoea, Fatigue — Feeling: Fair

Free text: Fatigue, severe allergies, shortness of breath and I have been in 40+ years of allergy shots

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Fatigue, Hypersensitivity, Joint swelling, Pre-existing disease, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: Swollen ankle, extreme fatigue, worse allergies, enormous exhaustion, joint pain. · Healthcare visit (other): Doppler/ultrasound, xrays, primary MD and ortho MD visit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-10
Call successful
Participant prefers to complete VAERS report online
2021-11-04
Dose 3 — Moderna
Co-administered: Other
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Pyrexia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: FEVER, EXTREME FATIGUE, THOUGHT OF GOING TO HOSPITAL YESTERDAY

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Fatigue or tiredness

Adult check-in
2021-11-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Joint pains, Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — day 7, dose 3
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-20
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-09
Survey response — day 35, dose 3
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair

Free text: Joint and soft tissue issue exacerbated since vaccinations. My mother had a STROKE AFTER 3rd PFIZER VACCINATION.

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Survey response — day 42, dose 3
MedDRA: Ear pain, Laryngitis, Pyrexia — 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

Free text: Laryngitis fever ear aches. My mother Had a major stroke after her third vaccination

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Report sent to call center — day 42, dose 3
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)
2021-12-20
Call 1 — Requested Callback
2021-12-23
Call 2 — Left Voicemail
2021-12-23
Callback requested for
04:00PM ET
2022-02-03
Survey response — 3 months, dose 3
MedDRA: Arthralgia, Office visit, Telemedicine — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Before vaccinations I never had severe joint pain in MANY PLACES. AND MY MOTHER HAD A BAD STROKE (SEVERE) after 3rd VACCINATION. She was PERFECTLY HEALTHY BEFORE!!! I WAS PERFECTLY HEALTHY BEFORE. I am a THERAPIST (OT) AND I BELIEVE THERE ARE SEVER · Healthcare visit (other): Consult in person and telehealth with MD for joint pain, and my mother has been hospitalized and in rehab. My mother tested positive to covid in rehab after 3 vaccinations and remained positive for a LONG TIME

MedDRA releases: 2024-11 · check-in free text available
2022-02-03
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-07
Call successful
Participant prefers to complete VAERS report online
2022-12-14
Dose 4 — Pfizer-BioNTech
2022-12-23
Survey response — day 7, dose 4
MedDRA: Mass, Medical counselling, Office visit, Thrombosis — Feeling: Poor · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Blood clot mass firmed next day. MD said blood clot · Healthcare visit (other): MD specialist appt 2 days ago

MedDRA releases: 2024-11 · check-in free text available
2022-12-23
Report sent to call center — day 7, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-27
Callback requested for
02:45PM ET
2022-12-27
Call successful
Completed over the phone
2022-12-28
Health check-in — day 14, dose 4
Feeling: Poor

Adult check-in
2023-01-04
Health check-in — day 21, dose 4
Feeling: Poor

Adult check-in
2023-01-14
Health check-in — day 28, dose 4
Feeling: Poor

Adult check-in
2023-01-18
Health check-in — day 35, dose 4
Feeling: Poor

Adult check-in
2023-01-25
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2023-03-16
Survey response — 3 months, dose 4
MedDRA: Arthralgia, Fatigue, Headache, Malaise, Thrombosis — Feeling: Poor · 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: 2024-11
2023-03-16
Report sent to call center — 3 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 · 1 call case(s)
2023-03-16
Call 1 — Left Voicemail
2023-03-16
Callback requested for
06:00PM ET

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-05	Moderna
3	2021-11-04	Moderna	Other
4	2022-12-14	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-14	priority 2/3
2021-05-09	Successful 2021-06-10	Participant prefers to complete VAERS report online
2021-12-18	Successful	Participant prefers to complete VAERS report online
2022-02-03	Successful 2022-02-07	Participant prefers to complete VAERS report online
2022-12-23	Successful 2022-12-27	Completed over the phone
2023-03-16	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-11

Systemic reaction (other): Sore tongue

2021-01-12

Systemic reaction (other): Weak, fluish, runny nose, sneezing

2021-01-13

Systemic reaction (other): Very Mild to no earache like sore throat maybe coming on nasal stuffiness runny nose. Occasional sneezing.

Release 2 — day 7, dose 1

2021-01-15

Systemic reaction (other): A little feverish.

Release 3 — day 0, dose 2

2021-02-05

Systemic reaction (other): I just got vaccination 30 minutes ago

Release 3 — days 1–6 daily, dose 2

2021-02-06

Systemic reaction (other): Pain in head, severe shaking with fever

2021-02-08

Systemic reaction (other): Feverish more mild on and off

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Almost like headache, some shortness of breath

Release 4 — day 7, dose 2

2021-02-12

Systemic reaction (other): Pretty significant pain in the side which I never get for 2 days. Arm still has a bump and visible redness at injection site

Release 4 — day 21, dose 2

2021-02-26

Symptoms: On and off flue like symptoms: feverish, nausea, colitis like symptoms severe at times. Runny nose, dizziness, laryngitis, mild earaches, etc.

Release 5 — day 28, dose 2

2021-03-05

Symptoms: Nasal congestion, sine chest congestion. Enormous fatigue.

Release 5 — day 35, dose 2

2021-03-12

Symptoms: Severe allergies after 40+ years of 6 allergy shots a week. Its like covid shots reversed allergy shots. Runny nose, itchy eyes, short of breath, dizzy, severe exhaustion.

Release 6 — day 42, dose 2

2021-03-19

Symptoms: Fatigue, severe allergies, shortness of breath and I have been in 40+ years of allergy shots

Release 8 — 3 months, dose 2

2021-05-09

Symptoms: Swollen ankle, extreme fatigue, worse allergies, enormous exhaustion, joint pain.

Healthcare visit (other): Doppler/ultrasound, xrays, primary MD and ortho MD visit.

Release 10 — days 1–6 daily, dose 3

2021-11-06

Systemic reaction (other): FEVER, EXTREME FATIGUE, THOUGHT OF GOING TO HOSPITAL YESTERDAY

Release 10 — day 35, dose 3

2021-12-09

Symptoms: Joint and soft tissue issue exacerbated since vaccinations. My mother had a STROKE AFTER 3rd PFIZER VACCINATION.

Release 10 — day 42, dose 3

2021-12-18

Symptoms: Laryngitis fever ear aches. My mother Had a major stroke after her third vaccination

Release 11 — 3 months, dose 3

2022-02-03

Symptoms: Before vaccinations I never had severe joint pain in MANY PLACES. AND MY MOTHER HAD A BAD STROKE (SEVERE) after 3rd VACCINATION. She was PERFECTLY HEALTHY BEFORE!!! I WAS PERFECTLY HEALTHY BEFORE. I am a THERAPIST (OT) AND I BELIEVE THERE ARE SEVER cut off by CDC

Healthcare visit (other): Consult in person and telehealth with MD for joint pain, and my mother has been hospitalized and in rehab. My mother tested positive to covid in rehab after 3 vaccinations and remained positive for a LONG TIME

Release 12 — day 7, dose 4

2022-12-23

Systemic reaction (other): Blood clot mass firmed next day. MD said blood clot

Healthcare visit (other): MD specialist appt 2 days ago

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	Arthralgia	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Telemedicine	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Colitis	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Eye pruritus	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Influenza like illness	✓	✓	✓
SD	Joint swelling	✓	✓	✓
SD	Laryngitis	✓	✓	✓
SD	Malaise	·	·	✓
SD	Nasal congestion	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Thrombosis	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Glossodynia	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Influenza like illness	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Mass	·	·	✓
SRO	Medical counselling	·	·	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Thrombosis	·	·	✓
SRO	Tremor	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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