2XZ-17348-75095

3 vaccinations 7 coded responses 34 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 46-50
ZIP prefix: 534 / WI
Registered: 2021-03-09

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Moderna
2021-03-09
Health check-in — day 0, dose 1
Feeling: Fair · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Raised tattoo ink

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

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: Flushing, Hot flush — Feeling: Good

Free text: Hot flashes and flushing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-16
Survey response — day 7, dose 1
MedDRA: Swelling — Feeling: Good · Headache, Joint pains, Muscle or body aches

Free text: Raised tattoo ink

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-06
Dose 2 — Moderna
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work or attend school

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-04-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-05
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-16
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-10-19
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-23
Survey response — day 7, dose 3
MedDRA: Injection site bruising — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Severe bruising at injection site

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-06
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-13
Survey response — day 28, dose 3
MedDRA: Asthenia, Fatigue — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Very tired and a loss of stamina and strength

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-27
Survey response — day 42, dose 3
MedDRA: Ear pain, Fatigue, Lethargy, Pyrexia — Feeling: Fair · Be unable to work or attend school

Free text: Feverish, ears hurt and a tiredness more then just being exhausted completely lethargic

MedDRA releases: 2024-11 · check-in free text available
2022-01-15
Survey response — 3 months, dose 3
MedDRA: Aphonia, Cough, Dysphonia, Headache, Oropharyngeal pain, Rash, Rhinorrhoea, Secretion discharge — Feeling: Poor · 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, Emergency room or emergency department visit

Free text: Rash dry cough mucus headache runny nose sore throat lost voice and hoarseness

MedDRA releases: 2024-11 · check-in free text available
2022-01-15
Report sent to call center — 3 months, dose 3
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 · Emergency room or emergency department visit · 1 call case(s)
2022-01-17
Call 1 — Left Voicemail
2022-01-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna
3	2021-10-16	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-01-15	Successful 2022-01-18	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-10

Systemic reaction (other): Raised tattoo ink

2021-03-14

Systemic reaction (other): Hot flashes and flushing

Release 5 — day 7, dose 1

2021-03-16

Systemic reaction (other): Raised tattoo ink

Release 10 — day 7, dose 3

2021-10-23

Systemic reaction (other): Severe bruising at injection site

Release 10 — day 28, dose 3

2021-11-13

Symptoms: Very tired and a loss of stamina and strength

Release 10 — day 42, dose 3

2021-11-27

Symptoms: Feverish, ears hurt and a tiredness more then just being exhausted completely lethargic

Release 10 — 3 months, dose 3

2022-01-15

Symptoms: Rash dry cough mucus headache runny nose sore throat lost voice and hoarseness

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	Aphonia	·	·	✓
SD	Asthenia	·	·	✓
SD	Cough	·	·	✓
SD	Dysphonia	·	·	✓
SD	Ear pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Lethargy	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Secretion discharge	·	·	✓
SRO	Flushing	✓	✓	✓
SRO	Hot flush	✓	✓	✓
SRO	Injection site bruising	·	·	✓
SRO	Swelling	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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