YZ6-73994-34931

4 vaccinations 17 coded responses 32 check-ins 16 free-text entries 9 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 300 / GA
Registered: 2021-01-06

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

2021-01-06
Registered in v-safe
2021-01-06
Dose 1 — Moderna
2021-01-06
Survey response — day 0, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: I have a number (7) of heart related health issuesI take a medication for microscopic colitis but I'm not having symptoms at the moment.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-07
Survey response — days 1–6 daily, dose 1
MedDRA: Diarrhoea — Feeling: Good · Site: Pain, Swelling · Diarrhea

Free text: I believe the diarrhea was caused by something else as it had started before I had the shot. It's very mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Survey response — day 14, dose 1
MedDRA: Unevaluable event — Feeling: Fair

Free text: Have a headache: be related to a very intense situation I was working on on someone elses behalf-equivalent of 7 full days and it will be ongoing again in about another week. Will try to be more cautious. Cortizone shot yesterday in right knee al

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-03
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-06
Dose 2 — Moderna
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Chills, Fatigue, Headache, Myalgia, Pain, Pain in extremity, Pyrexia — Feeling: Fair · Site: Pain, Swelling · Be unable to do your normal daily activities

Free text: I did not have chills, fever(101.4), headache, muscle or body aches, fatigue, weakness etc. today or Tuesday. But I did Sat. PM, Sun, & Mon. My arm hurt down through my fingers.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Dehydration, Insomnia, Muscle spasms, Pyrexia — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Was awakened three times in the night with severe leg cramps or Charlie horses. So I did not get much sleep. I was well hydrated so that wasnt the reason but I know I was dehydrated from fever over the weekend even though I drank a lot of smart water, wate,r and herbal tea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-20
Survey response — day 14, dose 2
MedDRA: Adverse reaction, Medical counselling, SARS-CoV-2 test, Sinusitis — 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

Free text: Symptoms: After the side effects from the shot I seem to have gone into a sinus infection · Healthcare visit (other): I was told by the PA to get a Covid test which I did yesterday at CVS. No results yet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-27
Survey response — day 21, dose 2
MedDRA: Infection, Unevaluable event — Feeling: Fair · 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: Have gone into secondary infections.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-06
Survey response — day 28, dose 2
MedDRA: Fatigue, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Very fatigues. Could possibly be one of my medications. · Healthcare visit (other): I have contacted the office via email

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-13
Survey response — day 35, dose 2
MedDRA: Bronchitis, Chills, Headache, Pain, Pyrexia, Sinusitis, Upper respiratory tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: After chills fever bodyaches and headache, I went into an upper respiratory infection end sinus infection and bronchitis. I am on my second round of medication and steroids to clear this up.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 42, dose 2
MedDRA: Condition aggravated, Immunisation reaction, Pre-existing disease, Sinusitis — Feeling: Fair · 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

Free text: Have acute bronchitis. Had a very bad reaction to the second Covid shot and went into a sinus infection and bronchitis that continues to linger.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-09
Survey response — 6 months, dose 2
MedDRA: Bronchitis, Bronchitis chronic, Office visit — Feeling: Fair · 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

Free text: Symptoms: Have had four bouts of bronchitis (two acute) since the second covid shot on Feb. 6. · Healthcare visit (other): Consults & visits with pulmonologist

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-09
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-16
Call 3 — Left Voicemail
2021-10-22
Dose 3 — Moderna
2022-02-06
Survey response — 12 months, dose 2
MedDRA: Balloon atrial septostomy, Colitis microscopic, Diarrhoea, Gastrooesophageal reflux disease, Pre-existing disease, Procedural complication — Feeling: Good · 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: Recent heart surgery. Didn't do mitral valve clip repair but atrial septostomy. Didn't help shortness of breath & not pulmonary. The (TEE) damaged esophagus so acid reflux now. Gastro dr gave 2nd med. Caused extreme diarrhea & microscopic colitis.

MedDRA releases: 2024-11 · check-in free text available
2022-02-06
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-07
Call 1 — Could Not Reach Participant
2022-02-10
Call 2 — Could Not Reach Participant
2022-04-22
Dose 4 — Pfizer-BioNTech
2022-04-27
Survey response — days 1–6 daily, dose 4
MedDRA: Office visit, Sciatica — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Today I went to the Roswell Surgery Center and had a injection into the sacroiliac area for sciatic nerve pain. I have had two previous but different shots that were not successful. · Healthcare visit (other): (b)(6) Surgery Center

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Report sent to call center — days 1–6 daily, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-28
Survey response — days 1–6 daily, dose 4
MedDRA: Office visit — Feeling: Fair · Be unable to do your normal daily activities

Free text: Had a sacroiliac injection yesterday at the (b)(6) surgery center

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
Call 2 — Left Voicemail
2022-04-29
Survey response — day 7, dose 4
MedDRA: Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Still having to be quiet from sacroiliac injection

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-22
Survey response — 3 months, dose 4
MedDRA: Hypersensitivity, Office visit, Pre-existing disease, Reflux laryngitis — Feeling: Good · 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: Symptoms: Acid reflux in throat and severe allergy flareup. · Healthcare visit (other): Two doctor visits

MedDRA releases: 2024-11 · check-in free text available
2022-07-22
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 · 1 call case(s)
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call X — Left Voicemail
2022-07-25
Call 3 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-10-21
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-04-22
Survey response — 12 months, dose 4
MedDRA: COVID-19, Medical counselling, Office visit, Respiratory tract congestion, Sinus congestion — Feeling: Good · 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
2023-04-22
Report sent to call center — 12 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 · 1 call case(s)
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 3 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-06	Moderna
2	2021-02-06	Moderna
3	2021-10-22	Moderna	No
4	2022-04-22	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-20	Unsuccessful
2021-02-27	Unsuccessful
2021-03-06	Unsuccessful
2021-03-20	Unsuccessful
2021-08-09	Unsuccessful
2022-02-06	Unsuccessful
2022-04-27	Unsuccessful
2022-07-22	Unsuccessful
2023-04-22	Unsuccessful

Free text

Release 1 — day 0, dose 1

2021-01-06

Systemic reaction (other): I have a number (7) of heart related health issuesI take a medication for microscopic colitis but I'm not having symptoms at the moment.

Release 1 — days 1–6 daily, dose 1

2021-01-07

Systemic reaction (other): I believe the diarrhea was caused by something else as it had started before I had the shot. It's very mild

Release 2 — day 14, dose 1

2021-01-22

Symptoms: Have a headache: be related to a very intense situation I was working on on someone elses behalf-equivalent of 7 full days and it will be ongoing again in about another week. Will try to be more cautious. Cortizone shot yesterday in right knee al

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): I did not have chills, fever(101.4), headache, muscle or body aches, fatigue, weakness etc. today or Tuesday. But I did Sat. PM, Sun, & Mon. My arm hurt down through my fingers.

2021-02-11

Systemic reaction (other): Was awakened three times in the night with severe leg cramps or Charlie horses. So I did not get much sleep. I was well hydrated so that wasnt the reason but I know I was dehydrated from fever over the weekend even though I drank a lot of smart water, wate,r and herbal tea.

Release 4 — day 14, dose 2

2021-02-20

Symptoms: After the side effects from the shot I seem to have gone into a sinus infection

Healthcare visit (other): I was told by the PA to get a Covid test which I did yesterday at CVS. No results yet

Release 4 — day 21, dose 2

2021-02-27

Symptoms: Have gone into secondary infections.

Release 5 — day 28, dose 2

2021-03-06

Symptoms: Very fatigues. Could possibly be one of my medications.

Healthcare visit (other): I have contacted the office via email

Release 5 — day 35, dose 2

2021-03-13

Symptoms: After chills fever bodyaches and headache, I went into an upper respiratory infection end sinus infection and bronchitis. I am on my second round of medication and steroids to clear this up.

Release 6 — day 42, dose 2

2021-03-20

Symptoms: Have acute bronchitis. Had a very bad reaction to the second Covid shot and went into a sinus infection and bronchitis that continues to linger.

Release 9 — 6 months, dose 2

2021-08-09

Symptoms: Have had four bouts of bronchitis (two acute) since the second covid shot on Feb. 6.

Healthcare visit (other): Consults & visits with pulmonologist

Release 11 — 12 months, dose 2

2022-02-06

Symptoms: Recent heart surgery. Didn't do mitral valve clip repair but atrial septostomy. Didn't help shortness of breath & not pulmonary. The (TEE) damaged esophagus so acid reflux now. Gastro dr gave 2nd med. Caused extreme diarrhea & microscopic colitis. cut off by CDC

Release 11 — days 1–6 daily, dose 4

2022-04-27

Systemic reaction (other): Today I went to the Roswell Surgery Center and had a injection into the sacroiliac area for sciatic nerve pain. I have had two previous but different shots that were not successful.

Healthcare visit (other): (b)(6) Surgery Center

redacted (b)(6)

2022-04-28

Systemic reaction (other): Had a sacroiliac injection yesterday at the (b)(6) surgery center

redacted (b)(6)

Release 11 — day 7, dose 4

2022-04-29

Systemic reaction (other): Still having to be quiet from sacroiliac injection

Release 12 — 3 months, dose 4

2022-07-22

Symptoms: Acid reflux in throat and severe allergy flareup.

Healthcare visit (other): Two doctor visits

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	Medical counselling	·	·	✓
HCVO	Office visit	✓	·	✓
HCVO	Respiratory tract congestion	·	·	✓
HCVO	SARS-CoV-2 test	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Balloon atrial septostomy	·	·	✓
SD	Bronchitis	✓	✓	✓
SD	Bronchitis chronic	✓	·	✓
SD	Chills	✓	✓	✓
SD	Colitis microscopic	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	·	·	✓
SD	Immunisation reaction	✓	✓	✓
SD	Infection	✓	·	✓
SD	Office visit	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Procedural complication	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Reflux laryngitis	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sinusitis	✓	✓	✓
SD	Unevaluable event	✓	✓	✓
SD	Upper respiratory tract infection	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Dehydration	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Office visit	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Sciatica	·	·	✓
SRO	Unevaluable event	○	○	✓

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