2FS-33847-29792

5 vaccinations 14 coded responses 49 check-ins 14 free-text entries 4 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 658 / MO
Registered: 2021-01-06

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

3SH-22216-86306 Child or adolescent in my care · Male · 2021-12-10

2VT-33982-49611 Child or adolescent in my care · Male · 2021-12-10

F6N-32034-86105 Adult relative or friend · Male · 2021-12-10

WXN-19488-91325 Adult relative or friend · Female · 2021-12-15

Timeline

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

2020-12-24
Dose 1 — Moderna
2021-01-06
Registered in v-safe
2021-01-06
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-07
Survey response — day 14, dose 1
MedDRA: Lethargy, Nausea — Feeling: Poor

Free text: Nauseated, lethargy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-22
Dose 2 — Moderna
2021-01-22
Survey response — day 28, dose 1
MedDRA: Nausea — Feeling: Fair

Free text: Nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-24
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased, Hypersomnia, Medical counselling, Palpitations — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): HR 110s for 13 hours before returning to 70s. Including while I was sleeping. 18-30 hours after administration. Slept 34 of last 44 hours. · Healthcare visit (other): Contacted MD about heart rate, pounding chest, and watch EKG showing inconclusive. He had a bed ready for me to go to observation, but I declined hospitalization. We agreed that I would go at HR >120. My max was 116.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-25
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Lightheaded to the point I had to sit down for several minutes-I havent been walking as much as normal as a result for the last few days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Nausea

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Nausea

Adult check-in
2021-02-01
Health check-in — day 7, dose 2
Feeling: Fair · Headache

Adult check-in
2021-02-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-02-21
Survey response — day 28, dose 2
MedDRA: Hypersensitivity, Self-medication, Urticaria — Feeling: Poor · 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: Allergic reaction-hives on IM steroid, oral prednisone, Benadryl, hydroxyzine, Pepcid, and Zyrtec likely from another med to be determined

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-05
Survey response — day 42, dose 2
MedDRA: Hypersensitivity, Nausea, Pruritus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nausea Allergic reaction Pruritus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — 3 months, dose 2
MedDRA: Headache, Nasal congestion, Nausea, Pain — Feeling: Good · 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: Nasal congestion, headache, nausea, bodyaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-07
Call successful
Participant prefers to complete VAERS report online
2021-07-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-10
Dose 3 — Moderna
2021-12-10
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-12
Survey response — days 1–6 daily, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Resting heart rate normal is 60. Has been in 90s since about 2 hrs after injection

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Survey response — days 1–6 daily, dose 3
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain

Free text: HR now down 10, but still up 20 from normal

MedDRA releases: 2024-11 · check-in free text available
2021-12-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-12-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-17
Health check-in — day 7, dose 3
Feeling: Fair · Fever · Diarrhea · Be unable to work or attend school

Adult check-in
2021-12-25
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-08
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-23
Survey response — day 42, dose 3
MedDRA: Fatigue, Headache, Hypersomnia, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Fair

Free text: Sore throat, runny nose, headache, sleeping 3 hours more, tired, COVID negative Binax 15, ihealth 18 and 22.

MedDRA releases: 2024-11 · check-in free text available
2022-03-13
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-12
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-07-17
Dose 4 — Moderna
2022-07-17
Health check-in — day 0, dose 4
Feeling: Good · Nausea

Adult check-in
2022-07-18
Survey response — days 1–6 daily, dose 4
MedDRA: Heart rate increased, Tinnitus — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Free text: Heart rate normally on 60a in 90s. Ringing in ears

MedDRA releases: 2024-11 · check-in free text available
2022-07-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Fatigue or tiredness, Nausea

Adult check-in
2022-07-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Fatigue or tiredness, Nausea

Adult check-in
2022-07-21
Survey response — days 1–6 daily, dose 4
MedDRA: Cough, Oropharyngeal pain, Tinnitus — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Ear ringing, Sore throat, cough

MedDRA releases: 2024-11 · check-in free text available
2022-07-24
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-08-07
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-16
Survey response — day 28, dose 4
MedDRA: Diarrhoea haemorrhagic — Feeling: Fair

Free text: Diarrhea with blood

MedDRA releases: 2024-11 · check-in free text available
2022-08-23
Survey response — day 35, dose 4
MedDRA: Diarrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diarrhea for 20 days

MedDRA releases: 2024-11 · check-in free text available
2022-08-23
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-08-24
Call 1 — Left Voicemail
2022-10-16
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-21
Dose 5 — Moderna
2022-11-22
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness, Diarrhea

Adult check-in
2022-11-24
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-11-27
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Muscle or body aches, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-12-08
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-12-12
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-12-19
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2023-01-02
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-24	Moderna
2	2021-01-22	Moderna
3	2021-12-10	Moderna	No
4	2022-07-17	Moderna	No
5	2022-11-21	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 1 — day 14, dose 1

2021-01-07

Symptoms: Nauseated, lethargy

Release 2 — day 28, dose 1

2021-01-22

Symptoms: Nausea

Release 2 — days 1–6 daily, dose 2

2021-01-24

Systemic reaction (other): HR 110s for 13 hours before returning to 70s. Including while I was sleeping. 18-30 hours after administration. Slept 34 of last 44 hours.

Healthcare visit (other): Contacted MD about heart rate, pounding chest, and watch EKG showing inconclusive. He had a bed ready for me to go to observation, but I declined hospitalization. We agreed that I would go at HR >120. My max was 116.

2021-01-25

Systemic reaction (other): Lightheaded to the point I had to sit down for several minutes-I havent been walking as much as normal as a result for the last few days

Release 4 — day 28, dose 2

2021-02-21

Symptoms: Allergic reaction-hives on IM steroid, oral prednisone, Benadryl, hydroxyzine, Pepcid, and Zyrtec likely from another med to be determined

Release 5 — day 42, dose 2

2021-03-05

Symptoms: Nausea Allergic reaction Pruritus

Release 7 — 3 months, dose 2

2021-04-25

Symptoms: Nasal congestion, headache, nausea, bodyaches

Release 10 — days 1–6 daily, dose 3

2021-12-12

Systemic reaction (other): Resting heart rate normal is 60. Has been in 90s since about 2 hrs after injection

2021-12-13

Systemic reaction (other): HR now down 10, but still up 20 from normal

Release 11 — day 42, dose 3

2022-01-23

Symptoms: Sore throat, runny nose, headache, sleeping 3 hours more, tired, COVID negative Binax 15, ihealth 18 and 22.

Release 12 — days 1–6 daily, dose 4

2022-07-18

Systemic reaction (other): Heart rate normally on 60a in 90s. Ringing in ears

2022-07-21

Systemic reaction (other): Ear ringing, Sore throat, cough

Release 12 — day 28, dose 4

2022-08-16

Symptoms: Diarrhea with blood

Release 12 — day 35, dose 4

2022-08-23

Symptoms: Diarrhea for 20 days

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	Heart rate increased	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Palpitations	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Diarrhoea haemorrhagic	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Hypersomnia	·	·	✓
SD	Lethargy	✓	✓	✓
SD	Nasal congestion	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Self-medication	✓	✓	✓
SD	Urticaria	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hypersomnia	✓	✓	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Tinnitus	·	·	✓
SRO	Unevaluable event	·	·	✓

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