4ET-15091-39975

3 vaccinations 5 coded responses 30 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 530 / WI
Registered: 2021-03-09

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
2021431 (opens in a new window)	high	10 / 11	2	1 of 3 VAERS symptoms	same dose (3)	WI matches	2021-12-04 / 2021-12-29 / 2022-01-10 received 329 days before the last call	case 1203645

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

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

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-11
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
2021-07-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-04
Dose 3 — Moderna
2022-01-05
Survey response — day 28, dose 3
MedDRA: Nasopharyngitis, Rash, Rash vesicular — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I have a cold, negative antigen test. I also have developed what appears to be a shingles rash on my face.

MedDRA releases: 2024-11 · check-in free text available
2022-01-05
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-08
Survey response — day 35, dose 3
MedDRA: Herpes zoster, Nasopharyngitis, Rash, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities

Free text: I have cold (tested negative using Binax at home self test). I also have a shingles like rash above my left eye.

MedDRA releases: 2024-11 · check-in free text available
2022-01-10
Call successful
Completed over the phone
2022-01-15
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-07
Survey response — 3 months, dose 3
MedDRA: Road traffic accident — 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

Free text: I experienced a car accident- not vaccine related.

MedDRA releases: 2024-11 · check-in free text available
2022-03-07
Report sent to call center — 3 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

Emergency room or emergency department visit · 1 call case(s)
2022-03-11
Call 1 — Left Voicemail
2022-06-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-04
Survey response — 12 months, dose 3
MedDRA: Cough, Viral infection — 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 · Outpatient clinic or urgent care clinic visit

Free text: I have had a persistent cough for a month. Chest X-ray clear for pneumonia. Dr. Said likely viral infection andRx an inhaler.

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
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)
2022-12-05
Call 2 — Left Voicemail
2022-12-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna
3	2021-12-04	Moderna	No

Call center

3 call center cases

1 successful · 2 unsuccessful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Light headed

Release 10 — day 28, dose 3

2022-01-05

Symptoms: I have a cold, negative antigen test. I also have developed what appears to be a shingles rash on my face.

Release 10 — day 35, dose 3

2022-01-08

Symptoms: I have cold (tested negative using Binax at home self test). I also have a shingles like rash above my left eye.

Release 11 — 3 months, dose 3

2022-03-07

Symptoms: I experienced a car accident- not vaccine related.

Release 12 — 12 months, dose 3

2022-12-04

Symptoms: I have had a persistent cough for a month. Chest X-ray clear for pneumonia. Dr. Said likely viral infection andRx an inhaler.

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	Herpes zoster	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Rash	·	·	✓
SD	Rash vesicular	·	·	✓
SD	Road traffic accident	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Viral infection	·	·	✓
SRO	Dizziness	✓	✓	✓

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