ZQL-13937-36787

3 vaccinations 12 coded responses 28 check-ins 12 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 907 / CA
Registered: 2021-04-16

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-14
Dose 1 — Moderna
2021-04-16
Registered in v-safe
2021-04-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-28
Survey response — day 14, dose 1
MedDRA: Blood urine present, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Pre existing condition, Polycystic L ovary. Blood in urine. · Healthcare visit (other): Appointment is tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-05
Survey response — day 21, dose 1
MedDRA: Abdominal distension, Gastrointestinal bacterial overgrowth, Irritable bowel syndrome, Polycystic ovaries, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: SIBO, IBS, polycystic ovary and bloating · Healthcare visit (other): Appointment 5/7/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-12
Dose 2 — Moderna
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Ovarian adhesion, Ovarian mass, Pelvic adhesions — Feeling: Fair · Site: Redness, Swelling · Abdominal pain

Free text: Three masses next to L ovary plus severe adhesions. Im having surgery May 17, 2021.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Pelvic mass, Surgery — Feeling: Fair · Site: Redness, Itching · Joint pains, Abdominal pain

Free text: Surgery to remove severe adhesions and 3 un-identified pelvic masses scheduled for 5/17/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None · Be unable to do your normal daily activities

Adult check-in
2021-05-18
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Abdominal pain · Be unable to do your normal daily activities

Free text: I had robotic surgery to remove polycystic ovary yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Good · Abdominal pain · Be unable to work

Free text: Post surgery

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-26
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-06-02
Survey response — day 21, dose 2
MedDRA: Exploratory operation, Gastric disorder, Medical counselling — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Gut problems not fixed with exploratory surgery. Referral to gastroenterologist. · Healthcare visit (other): My GP gave me emergency referral to gastroenterologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-09
Survey response — day 28, dose 2
MedDRA: Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Gastroenterologist scheduled colonoscopy and endoscopy

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

1 call case(s)
2021-06-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-23
Survey response — day 42, dose 2
MedDRA: Pain in extremity, Varicose vein — Feeling: Poor · Be unable to work or attend school

Free text: Extreme right leg pain. Varicose veins hurt.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Call 1 — Requested Callback
2021-06-28
Call 2 — Could Not Reach Participant
2021-06-29
Call 3 — Could Not Reach Participant
2021-06-29
Callback requested for
12:00PM ET
2021-08-12
Survey response — 3 months, dose 2
MedDRA: Adhesion, Cystitis, Gastrointestinal scarring, Scar — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bladder infection, exploratory surgery removed severe adhesions. Scar tissue on bladder and lower right intestines

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-12
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-17
Call 1 — Could Not Reach Participant
2021-08-20
Call 2 — Could Not Reach Participant
2021-11-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-30
Dose 3 — Moderna
2021-12-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-12-07
Health check-in — day 7, dose 3
Feeling: Fair · Site: Itching · Headache

Adult check-in
2021-12-14
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-21
Health check-in — day 21, dose 3
Feeling: Fair

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

Adult check-in
2022-01-06
Survey response — day 35, dose 3
MedDRA: Abdominal distension, Headache, Insomnia, Weight increased — Feeling: Fair · Be unable to do your normal daily activities

Free text: I waited to have my booster to take Xifaxan 550mg to no avail. We're not supposed to have vaccines while taking it. In one week I've gained weight, bloated, headaches, insomnia.

MedDRA releases: 2024-11 · check-in free text available
2022-01-12
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-03
Survey response — 3 months, dose 3
MedDRA: Insomnia, Pruritus — Feeling: Good · Be unable to do your normal daily activities

Free text: Insomnia still persists in spite of meditation, aerobic exercise. Itching after the shingle vaccine.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-14	Moderna
2	2021-05-12	Moderna
3	2021-11-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-28	Unsuccessful
2021-05-05	Unsuccessful
2021-06-02	Unsuccessful
2021-06-09	Unsuccessful
2021-08-12	Unsuccessful

Free text

Release 8 — day 14, dose 1

2021-04-28

Symptoms: Pre existing condition, Polycystic L ovary. Blood in urine.

Healthcare visit (other): Appointment is tomorrow

Release 8 — day 21, dose 1

2021-05-05

Symptoms: SIBO, IBS, polycystic ovary and bloating

Healthcare visit (other): Appointment 5/7/21

Release 8 — days 1–6 daily, dose 2

2021-05-14

Systemic reaction (other): Three masses next to L ovary plus severe adhesions. Im having surgery May 17, 2021.

2021-05-15

Systemic reaction (other): Surgery to remove severe adhesions and 3 un-identified pelvic masses scheduled for 5/17/21

2021-05-18

Systemic reaction (other): I had robotic surgery to remove polycystic ovary yesterday

Release 8 — day 7, dose 2

2021-05-19

Systemic reaction (other): Post surgery

Release 8 — day 21, dose 2

2021-06-02

Symptoms: Gut problems not fixed with exploratory surgery. Referral to gastroenterologist.

Healthcare visit (other): My GP gave me emergency referral to gastroenterologist.

Release 9 — day 28, dose 2

2021-06-09

Symptoms: Gastroenterologist scheduled colonoscopy and endoscopy

Release 9 — day 42, dose 2

2021-06-23

Symptoms: Extreme right leg pain. Varicose veins hurt.

Release 9 — 3 months, dose 2

2021-08-12

Symptoms: Bladder infection, exploratory surgery removed severe adhesions. Scar tissue on bladder and lower right intestines

Release 10 — day 35, dose 3

2022-01-06

Symptoms: I waited to have my booster to take Xifaxan 550mg to no avail. We're not supposed to have vaccines while taking it. In one week I've gained weight, bloated, headaches, insomnia.

Release 11 — 3 months, dose 3

2022-03-03

Symptoms: Insomnia still persists in spite of meditation, aerobic exercise. Itching after the shingle vaccine.

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	Unevaluable event	✓	✓	✓
SD	Abdominal distension	✓	✓	✓
SD	Adhesion	✓	·	✓
SD	Blood urine present	✓	✓	✓
SD	Cystitis	✓	·	✓
SD	Exploratory operation	✓	✓	✓
SD	Gastric disorder	✓	✓	✓
SD	Gastrointestinal bacterial overgrowth	✓	✓	✓
SD	Gastrointestinal scarring	✓	·	✓
SD	Headache	·	·	✓
SD	Insomnia	·	·	✓
SD	Irritable bowel syndrome	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Polycystic ovaries	✓	✓	✓
SD	Pruritus	·	·	✓
SD	Scar	✓	·	✓
SD	Varicose vein	✓	✓	✓
SD	Weight increased	·	·	✓
SRO	Ovarian adhesion	✓	·	✓
SRO	Ovarian mass	✓	✓	✓
SRO	Pelvic adhesions	○	✓	○
SRO	Pelvic mass	✓	✓	✓
SRO	Surgery	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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