ZRW-15817-95941

4 vaccinations 13 coded responses 53 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 212 / MD
Registered: 2021-03-10

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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Janssen/Johnson & Johnson
2021-03-10
Survey response — day 0, dose 1
MedDRA: Disorientation, Feeling abnormal, Hypoaesthesia — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Nausea

Free text: Spacey, face a bit numb, slightly disoriented

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

Free text: Feverish as well as chills. Felt dehydrated though hydrating well. Bad chills last night.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Hot flush — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Hot flashes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 21, single dose
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-06-09
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-09-08
Survey response — 6 months, dose 1
MedDRA: Adverse drug reaction, Malaise, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, 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: COVID like symptoms. Swab tests negative. I think I just test negative, plus Ibuse a neti pot that could throw the tests. Also bad antibiotics reaction.

MedDRA releases: 2024-11 · check-in free text available
2021-09-08
Report sent to call center — 6 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-12
Call 2 — Left Voicemail
2021-09-14
Call 3 — Left Voicemail
2021-09-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-03
Dose 2 — Moderna
2021-11-06
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-11
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-11-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-11-24
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-12-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-02-02
Survey response — 3 months, dose 2
MedDRA: Colitis ulcerative, Injection site pain, Malaise, Pre-existing disease — Feeling: Good · Be unable to work or attend school, 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: COVID like symptoms. I REALLY wonder if people on certain meds &/or autoimmune issues aren't testing properly. On & off arm pain at site. Ulcerative Colitis a bit worse.

MedDRA releases: 2024-11 · check-in free text available
2022-02-02
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-07
Call 1 — Left Voicemail
2022-02-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-23
Dose 3 — Moderna
2022-03-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-03-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-03-27
Survey response — days 1–6 daily, dose 3
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Sore throat, mild congestion feeling

MedDRA releases: 2024-11 · check-in free text available
2022-03-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-03-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-03-30
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-04-13
Survey response — day 21, dose 3
MedDRA: Fatigue, Headache, Nausea, Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Possible cold. Waiting for PCR test. Or allergies, sinus. Headache, sore throat, congestion, exhaustion, nausea. I wonder if due to immune issues I might not test right, though I still wear masks, distance, avoid most people.

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-04-27
Survey response — day 35, dose 3
MedDRA: Fatigue, Gastrointestinal disorder, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Allergies, tired. Strange stomach issue over the weekend

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — day 42, dose 3
MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Seems allergies/sinus

MedDRA releases: 2024-11 · check-in free text available
2022-06-22
Survey response — 3 months, dose 3
MedDRA: Cellulitis, Lymphoedema, 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: Probable cellulitis/dx cellulitis. Itching on my lymphedema arm, no visible skin problems

MedDRA releases: 2024-11 · check-in free text available
2022-06-22
Report sent to call center — 3 months, dose 3
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)
2022-06-23
Call 1 — Left Voicemail
2022-06-23
Call 2 — Left Voicemail
2022-06-23
Call 1 — Left Voicemail
2022-09-21
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-25
Dose 4 — Moderna
Co-administered: Flu
2022-09-26
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-09-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2022-09-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-03
Health check-in — day 7, dose 4
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-09
Survey response — day 14, dose 4
MedDRA: Abdominal discomfort, Fatigue, Headache — Feeling: Fair

Free text: Stomach distress, tired, headache

MedDRA releases: 2024-11 · check-in free text available
2022-10-16
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-23
Survey response — day 28, dose 4
MedDRA: Discomfort, Headache, Nausea, Respiratory tract congestion, SARS-CoV-2 test negative, Sinusitis — Feeling: Poor · 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: Sinus infection types of things~ headaches, pressure, congestion, nausea. 2 neg COVID tests, so thankful for that!

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Report sent to call center — day 28, 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)
2022-10-25
Call 2 — Left Voicemail
2022-10-25
Call 1 — Left Voicemail
2022-10-30
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-11-06
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-25
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2023-03-26
Survey response — 6 months, dose 4
MedDRA: Headache, Migraine, Nausea, Paranasal sinus discomfort, Sinus disorder, Vomiting — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Janssen/Johnson & Johnson
2	2021-11-03	Moderna	No
3	2022-03-23	Moderna	No
4	2022-09-25	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-09-08	Successful 2021-09-14	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-02	Successful 2022-02-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-22	Unsuccessful
2022-10-23	Unsuccessful

Free text

Release 5 — day 0, dose 1

2021-03-10

Systemic reaction (other): Spacey, face a bit numb, slightly disoriented

Release 5 — days 1–6 daily, dose 1

2021-03-11

Systemic reaction (other): Feverish as well as chills. Felt dehydrated though hydrating well. Bad chills last night.

2021-03-13

Systemic reaction (other): Hot flashes

Release 9 — 6 months, dose 1

2021-09-08

Symptoms: COVID like symptoms. Swab tests negative. I think I just test negative, plus Ibuse a neti pot that could throw the tests. Also bad antibiotics reaction.

Release 11 — 3 months, dose 2

2022-02-02

Symptoms: COVID like symptoms. I REALLY wonder if people on certain meds &/or autoimmune issues aren't testing properly. On & off arm pain at site. Ulcerative Colitis a bit worse.

Release 11 — days 1–6 daily, dose 3

2022-03-27

Systemic reaction (other): Sore throat, mild congestion feeling

Release 11 — day 21, dose 3

2022-04-13

Symptoms: Possible cold. Waiting for PCR test. Or allergies, sinus. Headache, sore throat, congestion, exhaustion, nausea. I wonder if due to immune issues I might not test right, though I still wear masks, distance, avoid most people.

Release 11 — day 35, dose 3

2022-04-27

Symptoms: Allergies, tired. Strange stomach issue over the weekend

Release 11 — day 42, dose 3

2022-05-04

Symptoms: Seems allergies/sinus

Release 12 — 3 months, dose 3

2022-06-22

Symptoms: Probable cellulitis/dx cellulitis. Itching on my lymphedema arm, no visible skin problems

Release 12 — day 14, dose 4

2022-10-09

Symptoms: Stomach distress, tired, headache

Release 12 — day 28, dose 4

2022-10-23

Symptoms: Sinus infection types of things~ headaches, pressure, congestion, nausea. 2 neg COVID tests, so thankful for that!

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
SD	Abdominal discomfort	·	·	✓
SD	Adverse drug reaction	·	·	✓
SD	Cellulitis	·	·	✓
SD	Colitis ulcerative	·	·	✓
SD	Discomfort	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	·	·	✓
SD	Injection site pain	·	·	✓
SD	Lymphoedema	·	·	✓
SD	Malaise	·	·	✓
SD	Migraine	·	·	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinus disorder	·	·	✓
SD	Sinusitis	·	·	✓
SD	Vomiting	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Dehydration	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Hot flush	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Respiratory tract congestion	·	·	✓

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