3XE-12517-92907

3 vaccinations 8 coded responses 39 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 079 / NJ
Registered: 2021-01-26

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

2021-01-26
Registered in v-safe
2021-01-26
Dose 1 — Moderna
2021-01-26
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-23
Dose 2 — Moderna
2021-02-23
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Rash — Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Developed a rash on abdomen on day 2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: 2days ago I started to have light headedness which still continues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lightheadedness still throughout the day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lightheadedness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — day 14, dose 2
MedDRA: Bed rest, Dizziness, Vertigo — Feeling: Poor · Be unable to do your normal daily activities

Free text: The lightheadedness has gotten worse. Today I havent been able to get out of bed due to vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — day 21, dose 2
MedDRA: Dizziness — Feeling: Fair

Free text: I still have times if lightheadedness and dizzy. This has been occasional since the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — day 28, dose 2
MedDRA: Dizziness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Still have light headedness and dizziness since the last dose of vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-15
Dose 3 — Moderna
2021-12-15
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-16
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-17
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-22
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-29
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-05
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-19
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-16
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-15
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-15
Survey response — 12 months, dose 3
MedDRA: Colitis — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Colitis

MedDRA releases: 2024-11 · check-in free text available
2022-12-15
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-12-16
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-23	Moderna
3	2021-12-15	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): Developed a rash on abdomen on day 2

2021-02-28

Systemic reaction (other): 2days ago I started to have light headedness which still continues

2021-03-01

Systemic reaction (other): Lightheadedness still throughout the day.

Release 4 — day 7, dose 2

2021-03-02

Systemic reaction (other): Lightheadedness

Release 5 — day 14, dose 2

2021-03-09

Symptoms: The lightheadedness has gotten worse. Today I havent been able to get out of bed due to vertigo

Release 5 — day 21, dose 2

2021-03-16

Symptoms: I still have times if lightheadedness and dizzy. This has been occasional since the vaccine.

Release 6 — day 28, dose 2

2021-03-23

Symptoms: Still have light headedness and dizziness since the last dose of vaccine

Release 12 — 12 months, dose 3

2022-12-15

Symptoms: Colitis

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	Bed rest	✓	✓	✓
SD	Colitis	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Vertigo	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Rash	✓	✓	✓

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