ZSD-31515-08505

2 vaccinations 8 coded responses 27 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 917 / CA
Registered: 2021-03-12

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Registered dependents

66C-30950-34164 Child or adolescent in my care · Female · 2021-08-18

C7Y-31636-78222 Child or adolescent in my care · Male · 2021-08-18

Timeline

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

2021-03-11
Dose 1 — Janssen/Johnson & Johnson
2021-03-12
Registered in v-safe
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · 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: Anxiety — Feeling: Fair · Headache

Free text: Anxiety

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 · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good

Free text: Itchy on legs but no rash visible

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Survey response — day 14, dose 1
MedDRA: Ear pain — Feeling: Good

Free text: Ear hurts feels like I have an ear infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — day 21, single dose
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 35, single dose
MedDRA: Office visit, Retinal haemorrhage — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: I was recently diagnosed with isolated retinal hemorrhage on my left eye. Doctor is conducting blood work next week and was informed about vaccine. · Healthcare visit (other): In person

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — day 35, single dose
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-21
Call 1 — Left Voicemail
2021-04-21
Call successful
Does not wish to fill out VAERS report
2021-04-22
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-06-10
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-09-09
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-11-30
Dose 2 — Pfizer-BioNTech
2021-12-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches

Adult check-in
2021-12-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-12-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-12-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-12-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-12-21
Survey response — day 21, dose 2
MedDRA: Chest discomfort, Chest pain, Injection site pruritus — Feeling: Good

Free text: Chest pains feels heavy and itchy on area with vaccine

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2022-01-04
Survey response — day 35, dose 2
MedDRA: Headache, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Had a fever last week, followed by a sore threat and headache. Lasted about 4 days, right now I only have a sore throat. I tested for Covid on day 2 of having symptoms and came back negative

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-03-01
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-05-31
Survey response — 6 months, dose 2
MedDRA: Chills, Cough, Headache, Pain, Pyrexia, Respiratory tract congestion — Feeling: Good · Be unable to work or attend school

Free text: Congestion, headaches, cough, fever, chills, body aches

MedDRA releases: 2024-11 · check-in free text available
2022-11-30
Survey response — 12 months, dose 2
MedDRA: Axillary pain, Breast pain, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Pain on right side of breast under arm · Healthcare visit (other): Regular doc visit, plus ultrasounf

MedDRA releases: 2024-11 · check-in free text available
2022-11-30
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-01
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-11	Janssen/Johnson & Johnson
2	2021-11-30	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-15	Successful 2021-04-21	Does not wish to fill out VAERS report
2022-11-30	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-13

Systemic reaction (other): Anxiety

2021-03-16

Systemic reaction (other): Itchy on legs but no rash visible

Release 6 — day 14, dose 1

2021-03-25

Symptoms: Ear hurts feels like I have an ear infection

Release 7 — day 35, single dose

2021-04-15

Symptoms: I was recently diagnosed with isolated retinal hemorrhage on my left eye. Doctor is conducting blood work next week and was informed about vaccine.

Healthcare visit (other): In person

Release 10 — day 21, dose 2

2021-12-21

Symptoms: Chest pains feels heavy and itchy on area with vaccine

Release 10 — day 35, dose 2

2022-01-04

Symptoms: Had a fever last week, followed by a sore threat and headache. Lasted about 4 days, right now I only have a sore throat. I tested for Covid on day 2 of having symptoms and came back negative

Release 11 — 6 months, dose 2

2022-05-31

Symptoms: Congestion, headaches, cough, fever, chills, body aches

Release 12 — 12 months, dose 2

2022-11-30

Symptoms: Pain on right side of breast under arm

Healthcare visit (other): Regular doc visit, plus ultrasounf

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	Axillary pain	·	·	✓
SD	Breast pain	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Chest pain	·	·	✓
SD	Chills	·	·	✓
SD	Cough	·	·	✓
SD	Ear pain	✓	✓	✓
SD	Headache	·	·	✓
SD	Injection site pruritus	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Retinal haemorrhage	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Anxiety	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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