39L-71105-70060

4 vaccinations 15 coded responses 36 check-ins 14 free-text entries 7 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 486 / MI
Registered: 2021-02-05

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Survey response — day 0, dose 1
MedDRA: Oral mucosal blistering — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Blisters in my mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Glossodynia, Oral mucosal blistering — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: The blisters in my mouth ars gond, buf my tongue is still sensitive

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Survey response — day 14, dose 1
MedDRA: Asthma, Office visit, Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I have had an asthma flair uo · Healthcare visit (other): Went to my doctor's office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Report sent to call center — day 14, dose 1
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)
2021-02-26
Survey response — day 21, dose 1
MedDRA: Asthma, Candida infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I have developed thrush, but it is probably do to having an asthma flair up last week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Dose 2 — Moderna
2021-03-05
Survey response — day 0, dose 2
MedDRA: Chest discomfort, Cold sweat, Diarrhoea, Dizziness, Immediate post-injection reaction, Medical observation, Nausea, Tremor — Feeling: Poor · Site: Pain · Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Right after I got the shot, I felt light headed, clammy, shakey and had chest tightness. They had me stay longet and drink some water and eat, but it made me nauseous. Came home and did a nebulizer treatment, but still a bit light headed, tight chest and now slight diarrhea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Chest discomfort, Nausea, Pain in extremity, Peripheral swelling, Rash, Rash pruritic — Feeling: Fair · Site: Pain, Swelling · Nausea · Be unable to do your normal daily activities

Free text: Last evening I endex up with an itchy rash on my wrist and hand. My chest was still tight and I felt nauseous until about 3:30 am, but since have only had arm Pain and swelling.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Chest discomfort, Middle ear effusion, Tinnitus — Feeling: Good · Fatigue or tiredness

Free text: Seem to have fluid in my ear tgat crackles, and my chest is tight.t is

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Survey response — day 7, dose 2
MedDRA: Middle ear effusion — Feeling: Good

Free text: Fluid in ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 14, dose 2
MedDRA: Rash — Feeling: Good

Free text: Had an alkergic reaction where I got a rash on my forearms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 21, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: My asthma is flairing up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Asthma, Pneumonia, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Asthma flair up a cold turning into a lung infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call successful
Participant prefers to complete VAERS report online
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-28
Dose 3 — Moderna
2021-10-28
Survey response — day 28, dose 3
MedDRA: Abdominal pain lower, Emergency care, Gallbladder disorder, Office visit — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Today I had severe pain on my right lower abdomen, so went to my doctor, who sent me to ER. They determined that my gall bladder isn't working well, so I need another test my doctor will order

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Report sent to call center — day 28, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-11-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-20
Call 2 — Left Voicemail
2021-12-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-29
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-28
Dose 4 — Moderna
2022-05-15
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-19
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-26
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-03
Survey response — day 35, dose 4
MedDRA: Allergic bronchitis, Asthma, Office visit, Pre-existing disease — 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

Free text: Symptoms: Diagnosed with allergy induced bronchitis and an asthma flare up · Healthcare visit (other): Went to my primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-06-03
Report sent to call center — day 35, 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

1 call case(s)
2022-06-03
Call 1 — Left Voicemail
2022-06-03
Call 1 — Left Voicemail
2022-06-03
Call 1 — Left Voicemail
2022-06-03
Call 1 — Left Voicemail
2022-06-03
Call 1 — Left Voicemail
2022-06-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-09
Survey response — day 42, dose 4
MedDRA: Chest discomfort, Ear discomfort, Nasal congestion, Oropharyngeal pain, Paranasal sinus hypersecretion, Rhinorrhoea — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: My lungs are tight, my sinuses drain constantly, causing soreness in the back of my throat, my ears are plugged, my nose stuffed and runny.

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-10
Call 1 — Left Voicemail
2022-07-28
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-27
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-28
Survey response — 12 months, dose 4
MedDRA: Blood iron decreased, COVID-19, Fatigue, Office visit — 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 · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-04-28
Report sent to call center — 12 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

Emergency room or emergency department visit · 1 call case(s)
2023-05-01
Call successful
Participant prefers to complete VAERS report online
2023-05-01
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-09-28	Moderna	No
4	2022-04-28	Moderna	No

Call center

7 call center cases

7 successful

3 waits over 3 months for a first call

See the call center timeline

Free text

Release 3 — day 0, dose 1

2021-02-05

Systemic reaction (other): Blisters in my mouth

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): The blisters in my mouth ars gond, buf my tongue is still sensitive

Release 4 — day 14, dose 1

2021-02-20

Symptoms: I have had an asthma flair uo

Healthcare visit (other): Went to my doctor's office

Release 4 — day 21, dose 1

2021-02-26

Symptoms: I have developed thrush, but it is probably do to having an asthma flair up last week.

Release 5 — day 0, dose 2

2021-03-05

Systemic reaction (other): Right after I got the shot, I felt light headed, clammy, shakey and had chest tightness. They had me stay longet and drink some water and eat, but it made me nauseous. Came home and did a nebulizer treatment, but still a bit light headed, tight chest and now slight diarrhea.

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Last evening I endex up with an itchy rash on my wrist and hand. My chest was still tight and I felt nauseous until about 3:30 am, but since have only had arm Pain and swelling.

2021-03-08

Systemic reaction (other): Seem to have fluid in my ear tgat crackles, and my chest is tight.t is

Release 5 — day 7, dose 2

2021-03-12

Systemic reaction (other): Fluid in ear

Release 6 — day 14, dose 2

2021-03-19

Symptoms: Had an alkergic reaction where I got a rash on my forearms

Release 6 — day 21, dose 2

2021-03-26

Symptoms: My asthma is flairing up

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: Asthma flair up a cold turning into a lung infection

Release 10 — day 28, dose 3

2021-10-28

Symptoms: Today I had severe pain on my right lower abdomen, so went to my doctor, who sent me to ER. They determined that my gall bladder isn't working well, so I need another test my doctor will order

Release 11 — day 35, dose 4

2022-06-03

Symptoms: Diagnosed with allergy induced bronchitis and an asthma flare up

Healthcare visit (other): Went to my primary care physician

Release 12 — day 42, dose 4

2022-06-09

Symptoms: My lungs are tight, my sinuses drain constantly, causing soreness in the back of my throat, my ears are plugged, my nose stuffed and runny.

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	Office visit	✓	✓	✓
SD	Abdominal pain lower	·	·	✓
SD	Allergic bronchitis	·	·	✓
SD	Asthma	✓	✓	✓
SD	Blood iron decreased	·	·	✓
SD	Candida infection	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	COVID-19	·	·	✓
SD	Ear discomfort	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	·	·	✓
SD	Gallbladder disorder	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Paranasal sinus hypersecretion	·	·	✓
SD	Pneumonia	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Cold sweat	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Glossodynia	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Medical observation	✓	✓	✓
SRO	Middle ear effusion	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash pruritic	✓	✓	✓
SRO	Tinnitus	✓	✓	✓
SRO	Tremor	✓	✓	✓

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