2Q3-15856-41275

5 vaccinations 20 coded responses 53 check-ins 19 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 189 / PA
Registered: 2021-01-28

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

2021-01-07
Dose 1 — Moderna
2021-01-28
Registered in v-safe
2021-01-28
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good · Site: Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Free text: Dry cough/ congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good

Free text: Dry cough, mild congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good · Headache

Free text: Dry cough/ congestion (normal for me due to allergies)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — day 7, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Fair · Chills, Headache, Fatigue or tiredness

Free text: Dry cough/ congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-09
Survey response — day 35, dose 2
MedDRA: Allergic respiratory symptom, Cough, Respiratory tract congestion, Sneezing — Feeling: Good

Free text: Allergy symptoms such as coughing sneezing congestion,etc

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 42, dose 2
MedDRA: Self-medication, Trigeminal neuralgia — Feeling: Good · Be unable to do your normal daily activities

Free text: Seemed like symptoms of trigeminal neuralgia on my left face for 2 days. Required otc analgesics ( ibuprofen/ acetaminophen) Now resolved.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Survey response — 3 months, dose 2
MedDRA: Hypersensitivity, Migraine, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Migraines, allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-03
Survey response — 6 months, dose 2
MedDRA: Pre-existing disease — Feeling: Good

Free text: Allergic asthma . My experience over the last few weeks has been nothing short of a miracle. I spent a lot of time with a Covid positive breakthrough vaccinated person who was sick with respiratory symptoms. I did not get sick and tested negative.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-12
Dose 3 — Moderna
2021-11-12
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-13
Survey response — days 1–6 daily, dose 3
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Free text: Lymphadenopathy in associated axilla

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling

Free text: Lymphadenopathy in axilla of affected arm

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Survey response — days 1–6 daily, dose 3
MedDRA: Rhinorrhoea — Feeling: Good · Site: Swelling · Headache, Fatigue or tiredness

Free text: Runny nose

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-18
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness

Free text: Coughing

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — day 7, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-11-26
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-03
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 28, dose 3
MedDRA: Aphthous ulcer — Feeling: Good

Free text: Aphthous ulcers in mouth

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-12
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-08
Dose 4 — Moderna
2022-04-09
Survey response — days 1–6 daily, dose 4
MedDRA: Syncope — Feeling: Poor · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Syncope

MedDRA releases: 2024-11 · check-in free text available
2022-04-10
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · Headache, Muscle or body aches

Adult check-in
2022-04-11
Survey response — days 1–6 daily, dose 4
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-04-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-04-14
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-04-15
Health check-in — day 7, dose 4
Feeling: Fair · Chills, Headache, Fatigue or tiredness

Adult check-in
2022-04-22
Survey response — day 14, dose 4
MedDRA: Cough — Feeling: Good

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-11
Survey response — 3 months, dose 4
MedDRA: Anosmia, Cough, Respiratory tract congestion, Sleep disorder, Sneezing — Feeling: Fair

Free text: Loss of smell, cough, severe congestion, sneezing, sleep disturbance

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Dose 5 — Moderna
2022-09-09
Health check-in — day 0, dose 5
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-09-10
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-09-11
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-09-12
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-16
Health check-in — day 7, dose 5
Feeling: Good · Headache

Adult check-in
2022-09-23
Survey response — day 14, dose 5
MedDRA: Presyncope, Vertigo — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Vertigo near syncope

MedDRA releases: 2024-11 · check-in free text available
2022-09-23
Report sent to call center — day 14, dose 5
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-09-26
Call 1 — Left Voicemail
2022-09-28
Call successful
Participant prefers to complete VAERS report online
2022-09-30
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-07
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-14
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-10-22
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-09
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-10
Survey response — 6 months, dose 5
MedDRA: Urinary tract infection — 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

MedDRA releases: 2024-11
2023-03-10
Report sent to call center — 6 months, dose 5
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)
2023-03-13
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-02	Moderna
3	2021-11-12	Moderna	No
4	2022-04-08	Moderna	No
5	2022-09-09	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-05

Systemic reaction (other): Dry cough/ congestion

2021-02-07

Systemic reaction (other): Dry cough, mild congestion

2021-02-08

Systemic reaction (other): Dry cough/ congestion (normal for me due to allergies)

Release 3 — day 7, dose 2

2021-02-09

Systemic reaction (other): Dry cough/ congestion

Release 5 — day 35, dose 2

2021-03-09

Symptoms: Allergy symptoms such as coughing sneezing congestion,etc

Release 5 — day 42, dose 2

2021-03-17

Symptoms: Seemed like symptoms of trigeminal neuralgia on my left face for 2 days. Required otc analgesics ( ibuprofen/ acetaminophen) Now resolved.

Release 8 — 3 months, dose 2

2021-05-06

Symptoms: Migraines, allergies

Release 9 — 6 months, dose 2

2021-08-03

Symptoms: Allergic asthma . My experience over the last few weeks has been nothing short of a miracle. I spent a lot of time with a Covid positive breakthrough vaccinated person who was sick with respiratory symptoms. I did not get sick and tested negative. cut off by CDC

Release 10 — days 1–6 daily, dose 3

2021-11-13

Systemic reaction (other): Shortness of breath

2021-11-14

Systemic reaction (other): Lymphadenopathy in associated axilla

2021-11-15

Systemic reaction (other): Lymphadenopathy in axilla of affected arm

2021-11-16

Systemic reaction (other): Runny nose

2021-11-18

Systemic reaction (other): Coughing

Release 10 — day 28, dose 3

2021-12-10

Symptoms: Aphthous ulcers in mouth

Release 11 — days 1–6 daily, dose 4

2022-04-09

Systemic reaction (other): Syncope

2022-04-11

Systemic reaction (other): Sore throat

Release 11 — day 14, dose 4

2022-04-22

Symptoms: Cough

Release 12 — 3 months, dose 4

2022-07-11

Symptoms: Loss of smell, cough, severe congestion, sneezing, sleep disturbance

Release 12 — day 14, dose 5

2022-09-23

Symptoms: Vertigo near syncope

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	Allergic respiratory symptom	✓	✓	✓
SD	Anosmia	·	·	✓
SD	Aphthous ulcer	·	·	✓
SD	Cough	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Presyncope	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Sleep disorder	·	·	✓
SD	Sneezing	✓	✓	✓
SD	Trigeminal neuralgia	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SD	Vertigo	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Dyspnoea	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinorrhoea	·	·	✓
SRO	Syncope	·	·	✓

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