3KU-32084-14469

2 vaccinations 9 coded responses 17 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 125 / NY
Registered: 2021-09-03

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

3FW-54446-84437 Child or adolescent in my care · Female · 2021-09-03

29V-10666-78092 Child or adolescent in my care · Male · 2021-09-03

Timeline

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

2021-09-03
Registered in v-safe
2021-09-03
Dose 1 — Moderna
2021-09-03
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-09-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-09-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Nausea

Adult check-in
2021-09-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-09-10
Survey response — day 7, dose 1
MedDRA: Myalgia, Pain in extremity — Feeling: Fair · Site: Pain · Muscle or body aches, Abdominal pain

Free text: Pain in left/sore oblique and left inner thigh

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

Adult check-in
2021-09-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-10-01
Dose 2 — Moderna
2021-10-01
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · None

Adult check-in
2021-10-02
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Elevated Heart Rate. Normal Resting HR is 54, last night my HR after resting was 150

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-03
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Very Elevated HeartRate Normal at Rest 56, since shot it went as high as 150 at rest

MedDRA releases: 2024-11 · check-in free text available
2021-10-03
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-04
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased, Vertigo — Feeling: Fair · Muscle or body aches

Free text: Vertigo, Elevated Heart Rate

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Survey response — days 1–6 daily, dose 2
MedDRA: Vertigo — Feeling: Fair · Headache, Nausea · Be unable to do your normal daily activities

Free text: Vertigo

MedDRA releases: 2024-11 · check-in free text available
2021-10-08
Survey response — day 7, dose 2
MedDRA: Vertigo — Feeling: Fair · Fatigue or tiredness

Free text: Vertigo

MedDRA releases: 2024-11 · check-in free text available
2021-10-17
Survey response — day 14, dose 2
MedDRA: Dyspnoea, Heart rate increased — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Rapid heart rate Shortness of breath after completing small tasks

MedDRA releases: 2024-11 · check-in free text available
2021-10-17
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-20
Call successful
Does not wish to fill out VAERS report
2021-10-20
Call successful
Does not wish to fill out VAERS report
2021-10-20
Call successful
Does not wish to fill out VAERS report
2021-10-22
Survey response — day 21, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair

Free text: Asthma has been active

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2022-10-03
Survey response — 12 months, dose 2
MedDRA: Heart rate increased, Menstruation irregular, Palpitations — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Rapid heart rate Palpitations Irregular periods

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-05
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-09-03	Moderna	No
2	2021-10-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-10-02	Successful 2021-10-20	Does not wish to fill out VAERS report
2021-10-03	Successful 2021-10-20	Does not wish to fill out VAERS report
2021-10-17	Successful 2021-10-20	Does not wish to fill out VAERS report
2022-10-03	Successful 2022-10-05	Does not wish to fill out VAERS report

Free text

Release 9 — day 7, dose 1

2021-09-10

Systemic reaction (other): Pain in left/sore oblique and left inner thigh

Release 9 — days 1–6 daily, dose 2

2021-10-02

Systemic reaction (other): Elevated Heart Rate. Normal Resting HR is 54, last night my HR after resting was 150

2021-10-03

Systemic reaction (other): Very Elevated HeartRate Normal at Rest 56, since shot it went as high as 150 at rest

Release 10 — days 1–6 daily, dose 2

2021-10-04

Systemic reaction (other): Vertigo, Elevated Heart Rate

2021-10-05

Systemic reaction (other): Vertigo

Release 10 — day 7, dose 2

2021-10-08

Systemic reaction (other): Vertigo

Release 10 — day 14, dose 2

2021-10-17

Symptoms: Rapid heart rate Shortness of breath after completing small tasks

Release 10 — day 21, dose 2

2021-10-22

Symptoms: Asthma has been active

Release 12 — 12 months, dose 2

2022-10-03

Symptoms: Rapid heart rate Palpitations Irregular periods

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	Asthma	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Menstruation irregular	·	·	✓
SD	Palpitations	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Heart rate increased	·	·	✓
SRO	Myalgia	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Vertigo	·	·	✓

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