2YU-16475-97368

3 vaccinations 11 coded responses 32 check-ins 11 free-text entries 6 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 925 / CA
Registered: 2021-03-25

Relationship: Self
Race: Other
Ethnicity: N/A

Timeline

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

2021-03-25
Registered in v-safe
2021-03-25
Dose 1 — Moderna
2021-03-25
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — day 7, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-04-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 21, dose 1
MedDRA: Back pain, Chest discomfort, Cough, Dyspepsia — Feeling: Fair

Free text: April 15 - some heartburn type feeling, upper chest pressure and intermittent cough. Some ongoing lower back pain in left side. Maybe heartburn today + seasonal allergies (because I have felt well for the most part except today).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Dose 2 — Moderna
2021-04-22
Survey response — day 0, dose 2
MedDRA: Pyrexia — Feeling: Fair · Site: Pain, Swelling · Fever · Muscle or body aches, Fatigue or tiredness

Free text: Starting to feel like I might have a mild fever.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Thirst — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: thirst, lack of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-29
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-06
Survey response — day 14, dose 2
MedDRA: Back pain, Pelvic pain, Physiotherapy — Feeling: Fair

Free text: I doubt its vaccine related but I have had more pronounced lower back/pelvic girdle area pain the last 2-3 days. But I am also doing a virtual physical therapy program that might be prompting it as my body gets used to some new exercises.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — day 21, dose 2
MedDRA: Back pain, Mobility decreased, Night sweats — 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

Free text: acute lower back pain that started May 9 and caused me mobility issues through May 13. I think it was injury related though. Also, in the last few days I have had some night sweats.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-20
Survey response — day 28, dose 2
MedDRA: Abdominal pain, Back pain, Constipation, Dizziness, Fatigue, Mobility decreased, Pelvic pain — Feeling: Fair · Be unable to work, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: On May 9 I woke up woth acute back pain that was likely from gardening work but it impeded my mobility for about 4 days. Around the same time, I have been dealing with symptoms of abdominal pain, pelvic girdle pain, dizziness, fatigue, constipation.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Report sent to call center — day 28, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-27
Survey response — day 35, dose 2
MedDRA: Abdominal pain, Back pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: My back pain issied improved but I have had low-level but continuous abdominal pain. I am awaiting results of ultrasound imaging that my doctor requested to see if there are any issues visible.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-24
Survey response — 3 months, dose 2
MedDRA: Office visit, Pregnancy — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Pregnancy. · Healthcare visit (other): routine prenatal care visits

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-24
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-26
Call 1 — Could Not Reach Participant
2021-07-29
Call 2 — Left Voicemail
2021-08-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-11-07
Survey response — day 7, dose 3
MedDRA: Pregnancy — Feeling: Good · Fatigue or tiredness

Free text: I am 26 weeks pregnant, so I cannot tell if I have fatigue from pregnancy or my booster shot.

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 35, dose 3
Feeling: Good

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

Adult check-in
2022-01-30
Survey response — 3 months, dose 3
MedDRA: Laryngitis, Nasopharyngitis — Feeling: Fair · Be unable to work or attend school, 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: seasonal cold, laryngitis

MedDRA releases: 2024-11 · check-in free text available
2022-01-30
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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-01
Call 1 — Could Not Reach Participant
2022-02-04
Call 2 — Could Not Reach Participant
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Caesarean section, Delivery, Nasopharyngitis, Surgery — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: I gave birth via C-section on (b)(6), 2022. I also have a cold right now. · Healthcare visit (other): surgery/recovery for childbirth

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-05-04
Call 1 — Could Not Reach Participant
2022-05-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-31
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-04-22	Moderna
3	2021-10-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-13	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-05-20	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-05-27	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-07-24	Successful 2021-08-03	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-30	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-29	Successful 2022-05-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 7 — day 21, dose 1

2021-04-15

Symptoms: April 15 - some heartburn type feeling, upper chest pressure and intermittent cough. Some ongoing lower back pain in left side. Maybe heartburn today + seasonal allergies (because I have felt well for the most part except today).

Release 7 — day 0, dose 2

2021-04-22

Systemic reaction (other): Starting to feel like I might have a mild fever.

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): thirst, lack of appetite

Release 8 — day 14, dose 2

2021-05-06

Symptoms: I doubt its vaccine related but I have had more pronounced lower back/pelvic girdle area pain the last 2-3 days. But I am also doing a virtual physical therapy program that might be prompting it as my body gets used to some new exercises.

Release 8 — day 21, dose 2

2021-05-13

Symptoms: acute lower back pain that started May 9 and caused me mobility issues through May 13. I think it was injury related though. Also, in the last few days I have had some night sweats.

Release 8 — day 28, dose 2

2021-05-20

Symptoms: On May 9 I woke up woth acute back pain that was likely from gardening work but it impeded my mobility for about 4 days. Around the same time, I have been dealing with symptoms of abdominal pain, pelvic girdle pain, dizziness, fatigue, constipation. cut off by CDC

Release 8 — day 35, dose 2

2021-05-27

Symptoms: My back pain issied improved but I have had low-level but continuous abdominal pain. I am awaiting results of ultrasound imaging that my doctor requested to see if there are any issues visible.

Release 9 — 3 months, dose 2

2021-07-24

Symptoms: Pregnancy.

Healthcare visit (other): routine prenatal care visits

Release 10 — day 7, dose 3

2021-11-07

Systemic reaction (other): I am 26 weeks pregnant, so I cannot tell if I have fatigue from pregnancy or my booster shot.

Release 11 — 3 months, dose 3

2022-01-30

Symptoms: seasonal cold, laryngitis

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: I gave birth via C-section on (b)(6), 2022. I also have a cold right now.

Healthcare visit (other): surgery/recovery for childbirth

redacted (b)(6)

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	Delivery	·	·	✓
HCVO	Office visit	✓	·	✓
HCVO	Surgery	·	·	✓
SD	Abdominal pain	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Caesarean section	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Constipation	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspepsia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Laryngitis	·	·	✓
SD	Mobility decreased	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Night sweats	✓	✓	✓
SD	Pelvic pain	✓	✓	✓
SD	Physiotherapy	✓	✓	✓
SD	Pregnancy	✓	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Pregnancy	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Thirst	✓	✓	✓

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