37U-32960-71091

4 vaccinations 10 coded responses 24 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 959 / CA
Registered: 2021-02-13

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

2021-02-10
Dose 1 — Moderna
2021-02-13
Registered in v-safe
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Oedema mucosal, Oral mucosal discolouration, Oral mucosal eruption — Feeling: Good · Site: Pain, Redness, Swelling · Headache, Muscle or body aches

Free text: Bottom lip mucosa inside of mouth has center white spot coupled with 2 pinheaded size white bumps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Oral disorder — Feeling: Fair · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Mouth pumps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 7, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Site: Pain · Chills, Nausea · Be unable to do your normal daily activities

Free text: Ulcerative colitis flare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-22
Dose 2 — Moderna
2021-03-24
Survey response — days 1–6 daily, dose 2
MedDRA: Emergency care, Immediate post-injection reaction, Loss of personal independence in daily activities, Malaise, Pharyngeal swelling, Self-medication, Urticaria — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): On the day of the vaccine I had swelling of my throat on the side where the vaccines was administered that started within second of the vaccination and lasted 20 minutes and I developed hives. I took Benadryl. On the second day of the vaccination I felt very very sick and was incapacitated. · Healthcare visit (other): Paramedics

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-25
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Fatigue — Feeling: Fair · Site: Pain, Swelling · Fever · Be unable to do your normal daily activities

Free text: Fatigue. Loss of energy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Good

Free text: Cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-28
Health check-in — day 35, dose 2
Feeling: Good

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

Adult check-in
2021-06-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-29
Dose 3 — Pfizer-BioNTech
2022-03-07
Call 1 — Could Not Reach Participant
2022-03-10
Call 2 — Left Voicemail
2022-03-10
Call successful
Reported to VAERS during previous contact from GDIT
2022-09-16
Dose 4 — Pfizer-BioNTech
2022-09-17
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-18
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good · Site: Pain, Redness, Swelling · Fever · Nausea

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-09-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-09-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-02
Survey response — day 14, dose 4
MedDRA: Decreased appetite, Fatigue — Feeling: Fair

Free text: Tired Lack of appetite for regular foods

MedDRA releases: 2024-11 · check-in free text available
2022-10-29
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-03-17
Survey response — 6 months, dose 4
MedDRA: Tinnitus — 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 · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-03-17
Report sent to call center — 6 months, dose 4
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)
2023-03-20
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna
2	2021-03-22	Moderna
3	2021-11-29	Pfizer-BioNTech	No
4	2022-09-16	Pfizer-BioNTech	No

Call center

2 call center cases

1 successful · 1 unsuccessful

VAERS report filed, before or during a call: 1

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-13

Systemic reaction (other): Bottom lip mucosa inside of mouth has center white spot coupled with 2 pinheaded size white bumps

2021-02-15

Systemic reaction (other): Mouth pumps

Release 4 — day 7, dose 1

2021-02-17

Systemic reaction (other): Ulcerative colitis flare

Release 6 — days 1–6 daily, dose 2

2021-03-24

Systemic reaction (other): On the day of the vaccine I had swelling of my throat on the side where the vaccines was administered that started within second of the vaccination and lasted 20 minutes and I developed hives. I took Benadryl. On the second day of the vaccination I felt very very sick and was incapacitated.

Healthcare visit (other): Paramedics

2021-03-25

Systemic reaction (other): Fatigue. Loss of energy

2021-03-26

Systemic reaction (other): Cough

2021-03-28

Systemic reaction (other): Cough

Release 12 — days 1–6 daily, dose 4

2022-09-18

Systemic reaction (other): No

Release 12 — day 14, dose 4

2022-10-02

Symptoms: Tired Lack of appetite for regular foods

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	Emergency care	✓	✓	✓
SD	Decreased appetite	·	·	✓
SD	Fatigue	·	·	✓
SD	Tinnitus	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Loss of personal independence in daily activities	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Oedema mucosal	○	✓	○
SRO	Oral disorder	✓	✓	✓
SRO	Oral mucosal discolouration	✓	·	✓
SRO	Oral mucosal eruption	✓	·	✓
SRO	Pharyngeal swelling	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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