ZS6-24115-63658

4 vaccinations 13 coded responses 34 check-ins 13 free-text entries 6 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 554 / MN
Registered: 2021-03-14

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

2021-03-14
Registered in v-safe
2021-03-14
Dose 1 — Janssen/Johnson & Johnson
2021-03-14
Health check-in — day 0, dose 1
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Note I have lupus so fatigue is a daily symptom so no different than my normal state

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Good

Free text: I have lupus and did not check symptoms today as back to normal levels as always have fatigue and GI issues daily with odds and ends joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-20
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Musculoskeletal discomfort, Pre-existing disease — Feeling: Good

Free text: Normal lupus fatigue and general joint discomfort

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — day 7, dose 1
MedDRA: Pre-existing disease — Feeling: Good

Free text: Normal lupus joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-04-11
Survey response — day 28, single dose
MedDRA: Sinus headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sinus headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — day 35, single dose
MedDRA: Diarrhoea, Gastroenteritis viral, Headache, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: I had stomach flu in bed for 5 days ie nausea vomiting diarrhea headache. It is steadily improving.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-06-13
Survey response — 3 months, dose 1
MedDRA: Fall, Retinal artery occlusion, Upper limb fracture — 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, Emergency room or emergency department visit

Free text: Small retinal occlusion diagnoses in May Also last Thursday fell and fracture right elbow awaiting surgery on Tuesday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Report sent to call center — 3 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-22
Call successful
Participant prefers to complete VAERS report online
2021-09-12
Survey response — 6 months, dose 1
MedDRA: Open reduction of fracture, Pyrexia, SARS-CoV-2 test negative, Sinusitis, Transient global amnesia, Upper limb fracture — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: Fracture elbow with ORIF in June; sinus infection with fever Aug 2021 negative Covid PCR test, day after sinus infection diagnosis had episode of transit global amnesia August all tests negative in work up for amnesia.

MedDRA releases: 2024-11 · check-in free text available
2021-09-12
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-14
Call 1 — Left Voicemail
2021-09-15
Call successful
Does not wish to fill out VAERS report
2021-10-26
Dose 2 — Moderna
2021-10-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-11-01
Survey response — days 1–6 daily, dose 2
MedDRA: Aphthous ulcer, Oral herpes — Feeling: Good

Free text: Cold sores in both nostrils and top lip. Also canker sore on tongue

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-02-23
Dose 3 — Moderna
2022-04-26
Survey response — 6 months, dose 2
MedDRA: Medical device removal, Pre-existing disease, Suture removal — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Removal of hardware and capitellar excision right elbow in March 2022 as follow up from capitellar fracture June 2021. Nothing to do with Covid vaccine or boosters.

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-27
Call 1 — Could Not Reach Participant
2022-05-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-08-24
Survey response — 6 months, dose 3
MedDRA: SARS-CoV-2 test negative, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus infection and have virtual visit planned this afternoon. Multiple home Covid test negative over past 2 weeks.

MedDRA releases: 2024-11 · check-in free text available
2022-08-24
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-08-25
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-10
Dose 4 — Moderna
2022-09-30
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-01
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-08
Survey response — day 28, dose 4
MedDRA: Basal cell carcinoma, Cryotherapy, Heavy exposure to ultraviolet light, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Cryotherapy to remove small superficial basal cell carcinoma on chest. Not related to Covid booster but was told due to previous sun exposure/ sun damage · Healthcare visit (other): Dermatologist appointment for treatment to small basal cell carcinoma

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-10
Survey response — 3 months, dose 4
MedDRA: Cough, Nasopharyngitis, Office visit, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Negative for Covid per testing but just getting over a cough and head cold that I had urgent care visit and obtained strong cough medicine and inhaler.

MedDRA releases: 2024-11 · check-in free text available
2022-12-10
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-12
Call 1 — Left Voicemail
2023-03-11
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-14	Janssen/Johnson & Johnson
2	2021-10-26	Moderna	No
3	2022-02-23	Moderna	No
4	2022-09-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-13	Successful 2021-06-22	Participant prefers to complete VAERS report online
2021-09-12	Successful 2021-09-15	Does not wish to fill out VAERS report
2022-04-26	Successful 2022-05-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-24	Successful 2022-08-25	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-08	Successful 2022-10-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-10	Unsuccessful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Note I have lupus so fatigue is a daily symptom so no different than my normal state

2021-03-17

Systemic reaction (other): I have lupus and did not check symptoms today as back to normal levels as always have fatigue and GI issues daily with odds and ends joint pain

Release 6 — days 1–6 daily, dose 1

2021-03-20

Systemic reaction (other): Normal lupus fatigue and general joint discomfort

Release 6 — day 7, dose 1

2021-03-21

Systemic reaction (other): Normal lupus joint pain

Release 7 — day 28, single dose

2021-04-11

Symptoms: Sinus headache

Release 7 — day 35, single dose

2021-04-19

Symptoms: I had stomach flu in bed for 5 days ie nausea vomiting diarrhea headache. It is steadily improving.

Release 9 — 3 months, dose 1

2021-06-13

Symptoms: Small retinal occlusion diagnoses in May Also last Thursday fell and fracture right elbow awaiting surgery on Tuesday

Release 9 — 6 months, dose 1

2021-09-12

Symptoms: Fracture elbow with ORIF in June; sinus infection with fever Aug 2021 negative Covid PCR test, day after sinus infection diagnosis had episode of transit global amnesia August all tests negative in work up for amnesia.

Release 10 — days 1–6 daily, dose 2

2021-11-01

Systemic reaction (other): Cold sores in both nostrils and top lip. Also canker sore on tongue

Release 11 — 6 months, dose 2

2022-04-26

Symptoms: Removal of hardware and capitellar excision right elbow in March 2022 as follow up from capitellar fracture June 2021. Nothing to do with Covid vaccine or boosters.

Release 12 — 6 months, dose 3

2022-08-24

Symptoms: Sinus infection and have virtual visit planned this afternoon. Multiple home Covid test negative over past 2 weeks.

Release 12 — day 28, dose 4

2022-10-08

Symptoms: Cryotherapy to remove small superficial basal cell carcinoma on chest. Not related to Covid booster but was told due to previous sun exposure/ sun damage

Healthcare visit (other): Dermatologist appointment for treatment to small basal cell carcinoma

Release 12 — 3 months, dose 4

2022-12-10

Symptoms: Negative for Covid per testing but just getting over a cough and head cold that I had urgent care visit and obtained strong cough medicine and inhaler.

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	Basal cell carcinoma	·	·	✓
HCVO	Office visit	·	·	✓
SD	Basal cell carcinoma	·	·	✓
SD	Cough	·	·	✓
SD	Cryotherapy	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Fall	✓	✓	✓
SD	Gastroenteritis viral	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heavy exposure to ultraviolet light	·	·	✓
SD	Medical device removal	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Office visit	·	·	✓
SD	Open reduction of fracture	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Retinal artery occlusion	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinus headache	✓	✓	✓
SD	Sinusitis	·	·	✓
SD	Suture removal	·	·	✓
SD	Transient global amnesia	·	·	✓
SD	Upper limb fracture	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Aphthous ulcer	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Musculoskeletal discomfort	✓	✓	✓
SRO	Oral herpes	·	·	✓
SRO	Pre-existing disease	✓	✓	✓

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