34D-16480-34277

4 vaccinations 15 coded responses 47 check-ins 14 free-text entries 11 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 921 / CA
Registered: 2021-02-09

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-09
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Abdominal pain

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Urinary tract infection — Feeling: Good

Free text: Uti

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Urinary tract infection — Feeling: Good · Headache

Free text: Pressure up, uti

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Arthritis — Feeling: Good

Free text: Arthritis pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Nausea, Abdominal pain

Adult check-in
2021-02-16
Health check-in — day 7, dose 1
Feeling: Fair · Headache

Adult check-in
2021-02-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-02
Survey response — day 21, dose 1
MedDRA: Vaginal pessary insertion, Vulvovaginal injury — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Vaginal tear from pessary- taking medication

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-09
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-13
Dose 2 — Moderna
2021-03-13
Health check-in — day 0, dose 2
Feeling: Good · Chills

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Abdominal pain

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-12
Survey response — 6 months, dose 2
MedDRA: Asthenia, Motion sickness, Nausea — Feeling: Poor · 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: Weakness, nausea, motion sickness

MedDRA releases: 2024-11 · check-in free text available
2021-09-12
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-13
Call 3 — Left Voicemail
2021-10-23
Dose 3 — Moderna
2021-10-23
Health check-in — day 0, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-10-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Breast pain — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Pain in breast and under arm

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Site: Itching · Muscle or body aches, Nausea · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Influenza and pneumovax-23 received today

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-31
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-06
Survey response — day 14, dose 3
MedDRA: Coronary artery disease, Lymphoma — 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: Immunoassay therapy for CAD and low grade lymphoma

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Report sent to call center — day 14, dose 3
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)
2021-11-09
Call 3 — Left Voicemail
2021-11-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-14
Survey response — day 21, dose 3
MedDRA: Cold type haemolytic anaemia, Lymphoma — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Lymphoma with cold agglutinin disease

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-16
Call successful
Participant prefers to complete VAERS report online
2021-11-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-23
Survey response — 3 months, dose 3
MedDRA: Abdominal pain, Headache — Feeling: Fair · 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: Severe headaches and abdominal pain

MedDRA releases: 2024-11 · check-in free text available
2022-01-23
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-25
Call 1 — Left Voicemail
2022-07-13
Dose 4 — Moderna
2022-07-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-07-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-22
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-08-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-10
Survey response — day 28, dose 4
MedDRA: Anaemia, Hypercalcaemia — Feeling: Poor · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Hypercalcemia, anemia

MedDRA releases: 2024-11 · check-in free text available
2022-08-10
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-08-11
Call 1 — Could Not Reach Participant
2022-08-11
Call 1 — Could Not Reach Participant
2022-08-11
Call 1 — Could Not Reach Participant
2022-08-11
Call 1 — Could Not Reach Participant
2022-08-11
Call 1 — Could Not Reach Participant
2022-08-11
Call 2 — Could Not Reach Participant
2022-08-11
Call 1 — Could Not Reach Participant
2022-08-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-17
Survey response — day 35, dose 4
MedDRA: Atrial fibrillation — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Atrial fibrillation

MedDRA releases: 2024-11 · check-in free text available
2022-08-17
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-08-19
Call 2 — Left Voicemail
2022-08-19
Call 2 — Left Voicemail
2022-08-19
Call 2 — Left Voicemail
2022-08-19
Call 2 — Left Voicemail
2022-08-19
Call 2 — Left Voicemail
2022-08-19
Call 3 — Left Voicemail
2022-08-19
Call 2 — Left Voicemail
2022-08-19
Call 1 — Left Voicemail
2022-08-25
Survey response — day 42, dose 4
MedDRA: Anaemia, Hypercalcaemia, Lymphoma — 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: Lymphoma, anemia, hypercalcemia

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-08-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-12
Survey response — 3 months, dose 4
MedDRA: Anaemia, COVID-19, Dyspnoea, Pleural effusion, Thrombocytopenia — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Covid-19, pleural effusion, shortness of breath, thrombocytopenia, transfusion dependent anemia

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-13
Call 2 — Left Voicemail
2023-01-11
Survey response — 6 months, dose 4
MedDRA: Death, Hypernatraemia, Pre-existing disease, Respiratory distress, SARS-CoV-2 test positive — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-01-11
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2023-01-12
Call 1 — Left Voicemail
2023-01-12
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-13	Moderna
3	2021-10-23	Moderna	No
4	2022-07-13	Moderna	No

Call center

11 call center cases

9 successful · 2 unsuccessful

3 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-12

Systemic reaction (other): Uti

2021-02-13

Systemic reaction (other): Pressure up, uti

2021-02-14

Systemic reaction (other): Arthritis pain

Release 4 — day 21, dose 1

2021-03-02

Symptoms: Vaginal tear from pessary- taking medication

Release 9 — 6 months, dose 2

2021-09-12

Symptoms: Weakness, nausea, motion sickness

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Pain in breast and under arm

2021-10-28

Systemic reaction (other): Influenza and pneumovax-23 received today

Release 10 — day 14, dose 3

2021-11-06

Symptoms: Immunoassay therapy for CAD and low grade lymphoma

Release 10 — day 21, dose 3

2021-11-14

Symptoms: Lymphoma with cold agglutinin disease

Release 11 — 3 months, dose 3

2022-01-23

Symptoms: Severe headaches and abdominal pain

Release 12 — day 28, dose 4

2022-08-10

Symptoms: Hypercalcemia, anemia

Release 12 — day 35, dose 4

2022-08-17

Symptoms: Atrial fibrillation

Release 12 — day 42, dose 4

2022-08-25

Symptoms: Lymphoma, anemia, hypercalcemia

Release 12 — 3 months, dose 4

2022-10-12

Symptoms: Covid-19, pleural effusion, shortness of breath, thrombocytopenia, transfusion dependent anemia

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	Abdominal pain	·	·	✓
SD	Anaemia	·	·	✓
SD	Asthenia	·	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Cold type haemolytic anaemia	·	·	✓
SD	Coronary artery disease	·	·	✓
SD	COVID-19	·	·	✓
SD	Death	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Headache	·	·	✓
SD	Hypercalcaemia	·	·	✓
SD	Hypernatraemia	·	·	✓
SD	Lymphoma	·	·	✓
SD	Motion sickness	·	·	✓
SD	Nausea	·	·	✓
SD	Pleural effusion	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory distress	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Thrombocytopenia	·	·	✓
SD	Vaginal pessary insertion	✓	✓	✓
SD	Vulvovaginal injury	✓	✓	✓
SRO	Arthritis	✓	✓	✓
SRO	Axillary pain	·	·	✓
SRO	Breast pain	·	·	✓
SRO	Unevaluable event	·	·	✓
SRO	Urinary tract infection	✓	✓	✓

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