36Y-21427-45754

3 vaccinations 8 coded responses 33 check-ins 8 free-text entries 4 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 210 / MD
Registered: 2021-03-14

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

2021-03-05
Dose 1 — Moderna
2021-03-14
Registered in v-safe
2021-03-14
Survey response — day 7, dose 1
MedDRA: Injection site rash, Rash — Feeling: Good · Site: Redness, Swelling, Itching · Rash, not including the immediate area around the injection site

Free text: Rash is around injection site but then all the way down upper arm, was worse yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-02
Dose 2 — Moderna
2021-04-02
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Pain — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Severe lower back pain/ache

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

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-09
Survey response — day 7, dose 2
MedDRA: Back pain — Feeling: Good · Fatigue or tiredness

Free text: Backache

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

Adult check-in
2021-04-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-07
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
2021-07-02
Survey response — 3 months, dose 2
MedDRA: Pregnancy — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Pregnancy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-07
Call 1 — Left Voicemail
2021-10-03
Survey response — 6 months, dose 2
MedDRA: Pregnancy — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2021-10-03
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-04
Dose 3 — Moderna
2021-12-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-12-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-11
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-20
Survey response — day 14, dose 3
MedDRA: Cough, Rhinorrhoea — Feeling: Fair

Free text: Slight cough and runny nose - caught from 3 year old daughter who tested negative for COVID

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-09
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-15
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-06
Survey response — 6 months, dose 3
MedDRA: Delivery — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Gave birth.

MedDRA releases: 2024-11 · check-in free text available
2022-06-06
Report sent to call center — 6 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

Hospitalization · 1 call case(s)
2022-06-07
Call 1 — Left Voicemail
2022-12-06
Survey response — 12 months, dose 3
MedDRA: COVID-19, Mastitis — 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 · Outpatient clinic or urgent care clinic visit

Free text: COVID-19, mastitis

MedDRA releases: 2024-11 · check-in free text available
2022-12-06
Report sent to call center — 12 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 · 1 call case(s)
2022-12-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-02	Moderna
3	2021-12-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-02	Successful 2021-10-05	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-03	Successful 2021-10-05	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-06	Successful 2022-12-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-06	Successful 2022-12-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — day 7, dose 1

2021-03-14

Systemic reaction (other): Rash is around injection site but then all the way down upper arm, was worse yesterday

Release 6 — days 1–6 daily, dose 2

2021-04-03

Systemic reaction (other): Severe lower back pain/ache

Release 7 — day 7, dose 2

2021-04-09

Systemic reaction (other): Backache

Release 9 — 3 months, dose 2

2021-07-02

Symptoms: Pregnancy

Release 9 — 6 months, dose 2

2021-10-03

Symptoms: Pregnancy

Release 10 — day 14, dose 3

2021-12-20

Symptoms: Slight cough and runny nose - caught from 3 year old daughter who tested negative for COVID

Release 11 — 6 months, dose 3

2022-06-06

Symptoms: Gave birth.

Release 12 — 12 months, dose 3

2022-12-06

Symptoms: COVID-19, mastitis

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	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Delivery	·	·	✓
SD	Mastitis	·	·	✓
SD	Pregnancy	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Injection site rash	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Rash	✓	✓	✓

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