ZC9-17674-60569

2 vaccinations 13 coded responses 25 check-ins 13 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 755 / TX
Registered: 2021-03-02

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

2021-03-02
Registered in v-safe
2021-03-02
Dose 1 — Moderna
2021-03-02
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Headache

Free text: None

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

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-09
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-16
Survey response — day 14, dose 1
MedDRA: Office visit, Peripheral swelling, Pruritus, Throat tightness, Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Itching began at vaccine site, then became hives all over both arms and my neck, and my arms became slightly swollen and warm to touch. My throat began to feel tight, so I went to my clinic for a steroid shot. Better today. · Healthcare visit (other): My usual family practice.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-23
Survey response — day 21, dose 1
MedDRA: Dyspnoea, Urticaria, Vaccination site pruritus — Feeling: Fair · 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: Extreme itching at site off vaccination, follows by hives all over both arms and part of my neck and upper back. Shortness of breath. Used inhaler and got steroid shot and antibiotics.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Survey response — 6 months, dose 1
MedDRA: Bronchitis, Colitis ulcerative, Pre-existing disease, Sinusitis — Feeling: Fair · 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: Microscopic ulcerative colitis flares, several severe; sinus infection, bronchitis

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-31
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)
2021-09-02
Call 1 — Could Not Reach Participant
2021-09-08
Call 2 — Could Not Reach Participant
2021-09-30
Dose 2 — Pfizer-BioNTech
2021-09-30
Survey response — day 0, dose 2
MedDRA: Adverse reaction, Colitis ulcerative — Feeling: Fair · Site: Pain · Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Symptoms caused by microscopic ulcerative colitis.

MedDRA releases: 2024-11 · check-in free text available
2021-10-01
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain, Colitis microscopic, Colitis ulcerative — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Abdominal pain from microscopic ulcerative colitis.

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2021-10-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-10-04
Survey response — days 1–6 daily, dose 2
MedDRA: Diarrhoea, Pyrexia — Feeling: Fair · Fever · Headache, Muscle or body aches, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Fever and diarrhea may be from my inflammatory bowel disease.

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Headache, Fatigue or tiredness, Vomiting, Diarrhea, Abdominal pain · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: All symptoms from flares of inflammatory bowel disease.

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-10-06
Survey response — days 1–6 daily, dose 2
MedDRA: Diarrhoea, Inflammatory bowel disease, Pyrexia — Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness, Diarrhea · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Fever and diarrhea from inflammatory bowel disease.

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-10-06
Call 1 — Could Not Reach Participant
2021-10-07
Survey response — day 7, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Symptoms likely caused by flare of inflammatory bowel disease.

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Call 1 — Could Not Reach Participant
2021-10-12
Call 2 — Could Not Reach Participant
2021-10-14
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-10-21
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-10-28
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-11-06
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-11-11
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-12-30
Survey response — 3 months, dose 2
MedDRA: Renal disorder — Feeling: Fair

Free text: I'm having problems with my right kidney, unrelated to the vaccines and booster. My urologist has scheduled a stint placement tomorrow.

MedDRA releases: 2024-11 · check-in free text available
2022-03-31
Survey response — 6 months, dose 2
MedDRA: Sinusitis, Stent placement — Feeling: Fair · 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: Kidney stent inserted. Sinus infection treated with Levaquin.

MedDRA releases: 2024-11 · check-in free text available
2022-03-31
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-04
Call 1 — Could Not Reach Participant
2022-04-07
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-02	Moderna
2	2021-09-30	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-16	Unsuccessful
2021-03-23	Unsuccessful
2021-08-31	Unsuccessful
2021-10-05	Unsuccessful
2021-10-06	Unsuccessful
2022-03-31	Unsuccessful

Free text

Release 4 — day 0, dose 1

2021-03-02

Systemic reaction (other): None

Release 5 — day 14, dose 1

2021-03-16

Symptoms: Itching began at vaccine site, then became hives all over both arms and my neck, and my arms became slightly swollen and warm to touch. My throat began to feel tight, so I went to my clinic for a steroid shot. Better today.

Healthcare visit (other): My usual family practice.

Release 6 — day 21, dose 1

2021-03-23

Symptoms: Extreme itching at site off vaccination, follows by hives all over both arms and part of my neck and upper back. Shortness of breath. Used inhaler and got steroid shot and antibiotics.

Release 9 — 6 months, dose 1

2021-08-31

Symptoms: Microscopic ulcerative colitis flares, several severe; sinus infection, bronchitis

Release 9 — day 0, dose 2

2021-09-30

Systemic reaction (other): Symptoms caused by microscopic ulcerative colitis.

Release 9 — days 1–6 daily, dose 2

2021-10-01

Systemic reaction (other): Abdominal pain from microscopic ulcerative colitis.

2021-10-02

Systemic reaction (other): None

2021-10-04

Systemic reaction (other): Fever and diarrhea may be from my inflammatory bowel disease.

Release 10 — days 1–6 daily, dose 2

2021-10-05

Systemic reaction (other): All symptoms from flares of inflammatory bowel disease.

2021-10-06

Systemic reaction (other): Fever and diarrhea from inflammatory bowel disease.

Release 10 — day 7, dose 2

2021-10-07

Systemic reaction (other): Symptoms likely caused by flare of inflammatory bowel disease.

Release 10 — 3 months, dose 2

2021-12-30

Symptoms: I'm having problems with my right kidney, unrelated to the vaccines and booster. My urologist has scheduled a stint placement tomorrow.

Release 11 — 6 months, dose 2

2022-03-31

Symptoms: Kidney stent inserted. Sinus infection treated with Levaquin.

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	✓	✓	✓
SD	Bronchitis	✓	·	✓
SD	Colitis ulcerative	✓	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Pruritus	✓	✓	✓
SD	Renal disorder	·	·	✓
SD	Sinusitis	✓	·	✓
SD	Stent placement	·	·	✓
SD	Throat tightness	✓	✓	✓
SD	Urticaria	✓	✓	✓
SD	Vaccination site pruritus	✓	✓	✓
SRO	Abdominal pain	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Colitis microscopic	·	·	✓
SRO	Colitis ulcerative	·	·	✓
SRO	Condition aggravated	·	·	✓
SRO	Diarrhoea	·	·	✓
SRO	Inflammatory bowel disease	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pyrexia	·	·	✓

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