Z6R-28840-58502

2 vaccinations 16 coded responses 22 check-ins 16 free-text entries 4 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 019 / MA
Registered: 2021-03-06

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

2021-03-06
Registered in v-safe
2021-03-06
Dose 1 — Janssen/Johnson & Johnson
2021-03-06
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain, Swelling · Nausea

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Dyspnoea — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Dizziness occasionally; some shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Chills — Feeling: Fair · Site: Pain · Chills, Joint pains, Muscle or body aches, Nausea

Free text: Chills were overnight last night. Seem to be gone for now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal pain — Feeling: Fair · Site: Pain, Swelling · Nausea, Abdominal pain

Free text: Abdominal pain was last night/early this a.m. (while trying to sleep.) Has passed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Joint pains, Fatigue or tiredness, Nausea

Adult check-in
2021-03-13
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Chills, Muscle or body aches, Nausea

Adult check-in
2021-03-20
Survey response — day 14, dose 1
MedDRA: Cough, Nasopharyngitis, Rhinorrhoea — Feeling: Fair

Free text: Cold sx, runny nose, cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — day 21, single dose
MedDRA: Headache, Pain — Feeling: Good

Free text: Achy, headaches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — day 28, single dose
MedDRA: Arthralgia, Myalgia, Pyrexia — Feeling: Fair

Free text: Low fever, achy muscles and joints

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — day 35, single dose
MedDRA: Abdominal pain upper — Feeling: Fair

Free text: Stomach cramps on and off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — day 42, single dose
MedDRA: Abdominal pain upper, Myalgia — Feeling: Good

Free text: Muscle aches, stomach cramps. Not sure if related to vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
Survey response — 3 months, dose 1
MedDRA: Disturbance in attention, Fatigue — Feeling: Good

Free text: Fatigue, hard time concentrating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-04
Survey response — 6 months, dose 1
MedDRA: Back pain, Pre-existing disease, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Mid back pain. Covid negative test but lungs feel like when I had pnemonia

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-04
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-10
Call successful
Participant prefers to complete VAERS report online
2021-10-24
Dose 2 — Moderna
2021-10-31
Health check-in — day 7, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-11-14
Survey response — day 21, dose 2
MedDRA: Myalgia — Feeling: Fair

Free text: Muscle pain in legs

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Survey response — day 28, dose 2
MedDRA: Muscle spasms, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Leg cramps/pain

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-12-05
Survey response — day 42, dose 2
MedDRA: Arthralgia, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Continued achy legs. Joint pain.

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-08
Call 1 — Left Voicemail
2022-04-24
Survey response — 6 months, dose 2
MedDRA: Cerebellar stroke, Deafness, Magnetic resonance imaging head abnormal, Office visit, Tinnitus — 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: Dx with chronic cerebellar stroke. Woke with tinnitus, went to ENT because persistent. Found some assymetrical hearing loss, brain MRI showed stroke.

MedDRA releases: 2024-11 · check-in free text available
2022-04-24
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-25
Call 1 — Left Voicemail
2022-05-06
Call successful
Participant prefers to complete VAERS report online
2022-05-06
Call successful
Participant prefers to complete VAERS report online
2022-10-26
Survey response — 12 months, dose 2
MedDRA: Cardiac disorder, Heart failure with preserved ejection fraction, Office visit, Pre-existing disease, Tinnitus — 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: Newly identified heart failure with preserved ejection. Ears ringing since March, getting worse. Not sure if either related to covid vaccines. Discovery of cerebellar infarct that was on images 11 years ago. · Healthcare visit (other): In person specialist visits, many tests related to heart and old stroke

MedDRA releases: 2024-11 · check-in free text available
2022-10-26
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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-27
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Janssen/Johnson & Johnson
2	2021-10-24	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-04	Successful 2021-09-10	Participant prefers to complete VAERS report online
2021-12-05	Successful 2022-05-06	Participant prefers to complete VAERS report online
2022-04-24	Successful 2022-05-06	Participant prefers to complete VAERS report online
2022-10-26	Successful 2022-10-27	Participant prefers to complete VAERS report online

Free text

Release 5 — day 0, dose 1

2021-03-06

Systemic reaction (other): No

Release 5 — days 1–6 daily, dose 1

2021-03-07

Systemic reaction (other): Dizziness occasionally; some shortness of breath

2021-03-08

Systemic reaction (other): Chills were overnight last night. Seem to be gone for now.

2021-03-09

Systemic reaction (other): Abdominal pain was last night/early this a.m. (while trying to sleep.) Has passed.

Release 6 — day 14, dose 1

2021-03-20

Symptoms: Cold sx, runny nose, cough

Release 6 — day 21, single dose

2021-03-27

Symptoms: Achy, headaches.

Release 6 — day 28, single dose

2021-04-03

Symptoms: Low fever, achy muscles and joints

Release 7 — day 35, single dose

2021-04-10

Symptoms: Stomach cramps on and off

Release 7 — day 42, single dose

2021-04-19

Symptoms: Muscle aches, stomach cramps. Not sure if related to vaccine.

Release 8 — 3 months, dose 1

2021-06-05

Symptoms: Fatigue, hard time concentrating

Release 9 — 6 months, dose 1

2021-09-04

Symptoms: Mid back pain. Covid negative test but lungs feel like when I had pnemonia

Release 10 — day 21, dose 2

2021-11-14

Symptoms: Muscle pain in legs

Release 10 — day 28, dose 2

2021-11-21

Symptoms: Leg cramps/pain

Release 10 — day 42, dose 2

2021-12-05

Symptoms: Continued achy legs. Joint pain.

Release 11 — 6 months, dose 2

2022-04-24

Symptoms: Dx with chronic cerebellar stroke. Woke with tinnitus, went to ENT because persistent. Found some assymetrical hearing loss, brain MRI showed stroke.

Release 12 — 12 months, dose 2

2022-10-26

Symptoms: Newly identified heart failure with preserved ejection. Ears ringing since March, getting worse. Not sure if either related to covid vaccines. Discovery of cerebellar infarct that was on images 11 years ago.

Healthcare visit (other): In person specialist visits, many tests related to heart and old stroke

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	Cardiac disorder	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Pre-existing disease	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	·	✓
SD	Cerebellar stroke	·	·	✓
SD	Cough	✓	✓	✓
SD	Deafness	·	·	✓
SD	Disturbance in attention	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart failure with preserved ejection fraction	·	·	✓
SD	Magnetic resonance imaging head abnormal	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Office visit	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Tinnitus	·	·	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	No adverse event	✓	✓	✓

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