YT5-96958-37801

3 vaccinations 12 coded responses 45 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 546 / WI
Registered: 2021-04-08

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

2021-04-08
Registered in v-safe
2021-04-08
Dose 1 — Janssen/Johnson & Johnson
2021-04-08
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia — Feeling: Good · Chills, Joint pains

Free text: Joint pains had prior to vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-15
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-22
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-29
Survey response — day 21, single dose
MedDRA: Chills, Fatigue, Hypersomnia — Feeling: Good · Be unable to do your normal daily activities

Free text: Had chills off & on & was very tired & slept a lot a few days ago.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-07-08
Survey response — 3 months, dose 1
MedDRA: Dizziness, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Lightheaded after breakfast on 4 consecutive days in June. · Healthcare visit (other): Was seen by doctor in regular clinic & had EKG. Was referred to a cardiologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Report sent to call center — 3 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-12
Call 2 — Left Voicemail
2021-10-11
Survey response — 6 months, dose 1
MedDRA: Dyspnoea exertional, Pre-existing disease, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Getting winded walking up stairs & around the block. Premature Ventricular Contractions were diagnosed 2 years ago. I still have them & now may need to go on medication for them. Recently I did have an echocardiogram & stress test. · Healthcare visit (other): See previous notes about echocardiogram & stress test

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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-13
Call 2 — Left Voicemail
2021-12-27
Dose 2 — Moderna
2021-12-27
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-12-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · Fatigue or tiredness

Adult check-in
2021-12-29
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Site: Itching · Muscle or body aches

Free text: Want to mention that I'm doing this for the Moderna booster I received, not the 2-shot vaccine.

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-01-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches

Adult check-in
2022-01-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2022-01-03
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-01-10
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2022-01-17
Survey response — day 21, dose 2
MedDRA: Dry throat, Headache, Throat irritation — Feeling: Fair

Free text: Headachey & some dry scratchy throat for one day

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2022-01-31
Survey response — day 35, dose 2
MedDRA: Headache, Nasopharyngitis — Feeling: Fair

Free text: Headachey like a head cold starting

MedDRA releases: 2024-11 · check-in free text available
2022-02-07
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2022-03-28
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Limb discomfort — Feeling: Good

Free text: Pain in right knee occasionally within last 2 weeks. Occasional discomfort in lower left leg area.

MedDRA releases: 2024-11 · check-in free text available
2022-06-29
Survey response — 6 months, dose 2
MedDRA: Chills, Cough, Head discomfort, Myalgia, Oropharyngeal pain, Pain, Sinus headache, Sneezing — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: 2 days of sore throat, then 2 days of body/muscle aches, then chills 1 day. Since then, some sinus headaches, pressure at my temples, sneezing & coughing. Allergies I never had before?

MedDRA releases: 2024-11 · check-in free text available
2022-06-29
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-30
Call 1 — Left Voicemail
2022-06-30
Call 1 — Left Voicemail
2022-06-30
Call 1 — Left Voicemail
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-18
Dose 3 — Moderna
2022-07-18
Health check-in — day 0, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-07-19
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches

Adult check-in
2022-07-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-07-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness · None

Adult check-in
2022-07-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-07-23
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-07-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2022-07-25
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-08-01
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-08-08
Survey response — day 21, dose 3
MedDRA: Arthralgia, Asthenia, Pain in extremity — Feeling: Fair

Free text: Pain in top of feet, in upper arm (especially upon waking), in wrists & not much energy

MedDRA releases: 2024-11 · check-in free text available
2022-08-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-08-22
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-08-30
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-10-19
Survey response — 3 months, dose 3
MedDRA: Balance disorder, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Was feeling unsteady on at least 3 days. Not dizzy & not vertigo. Saw my doctor. May have been caused by stopping taking ginseng which had been taking daily for some time.

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-20
Call 1 — Left Voicemail
2023-01-16
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-08	Janssen/Johnson & Johnson
2	2021-12-27	Moderna	No
3	2022-07-18	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-08	Successful 2022-06-30	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-11	Successful 2022-06-30	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-29	Successful 2022-06-30	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-19	Unsuccessful

Free text

Release 7 — day 0, dose 1

2021-04-08

Systemic reaction (other): No

Release 7 — days 1–6 daily, dose 1

2021-04-09

Systemic reaction (other): Joint pains had prior to vaccine.

Release 8 — day 21, single dose

2021-04-29

Symptoms: Had chills off & on & was very tired & slept a lot a few days ago.

Release 9 — 3 months, dose 1

2021-07-08

Symptoms: Lightheaded after breakfast on 4 consecutive days in June.

Healthcare visit (other): Was seen by doctor in regular clinic & had EKG. Was referred to a cardiologist.

Release 10 — 6 months, dose 1

2021-10-11

Symptoms: Getting winded walking up stairs & around the block. Premature Ventricular Contractions were diagnosed 2 years ago. I still have them & now may need to go on medication for them. Recently I did have an echocardiogram & stress test.

Healthcare visit (other): See previous notes about echocardiogram & stress test

Release 10 — days 1–6 daily, dose 2

2021-12-29

Systemic reaction (other): Want to mention that I'm doing this for the Moderna booster I received, not the 2-shot vaccine.

Release 10 — day 21, dose 2

2022-01-17

Symptoms: Headachey & some dry scratchy throat for one day

Release 11 — day 35, dose 2

2022-01-31

Symptoms: Headachey like a head cold starting

Release 11 — 3 months, dose 2

2022-03-28

Symptoms: Pain in right knee occasionally within last 2 weeks. Occasional discomfort in lower left leg area.

Release 12 — 6 months, dose 2

2022-06-29

Symptoms: 2 days of sore throat, then 2 days of body/muscle aches, then chills 1 day. Since then, some sinus headaches, pressure at my temples, sneezing & coughing. Allergies I never had before?

Release 12 — day 21, dose 3

2022-08-08

Symptoms: Pain in top of feet, in upper arm (especially upon waking), in wrists & not much energy

Release 12 — 3 months, dose 3

2022-10-19

Symptoms: Was feeling unsteady on at least 3 days. Not dizzy & not vertigo. Saw my doctor. May have been caused by stopping taking ginseng which had been taking daily for some time.

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	Office visit	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Asthenia	·	·	✓
SD	Balance disorder	·	·	✓
SD	Chills	✓	✓	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dry throat	·	·	✓
SD	Dyspnoea exertional	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Head discomfort	·	·	✓
SD	Headache	·	·	✓
SD	Hypersomnia	✓	✓	✓
SD	Limb discomfort	·	·	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sinus headache	·	·	✓
SD	Sneezing	·	·	✓
SD	Throat irritation	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Unevaluable event	·	·	✓

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