4KD-18884-07849

4 vaccinations 7 coded responses 44 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 993 / WA
Registered: 2021-01-27

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
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · 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
Survey response — day 21, dose 1
MedDRA: Sinus congestion, Tinnitus — Feeling: Fair

Free text: Roaring in my ears. Sinuses feel full, but not sick.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-24
Dose 2 — Moderna
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches

Free text: My normal temp is 97.5

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: Good · Site: Itching · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-03-03
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-03-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2021-10-25
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · Fatigue or tiredness, Diarrhea

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Blister, Erythema, Swelling — Feeling: Fair · Site: Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Have small a couple blisters on top of red swollen area

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Swelling, Itching · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Swelling, Itching · None

Adult check-in
2021-11-03
Survey response — day 7, dose 3
MedDRA: Emergency care, Haematochezia, Large intestine infection, Pain, Pneumonia — Feeling: Fair · 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: Systemic reaction (other): ER Monday for severe pain &blood in stool they said I had pneumonia & infection in lrg intestine · Healthcare visit (other): Pneumonia & infection in large intestine

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Report sent to call center — day 7, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-11-04
Call 1 — Left Voicemail
2021-11-04
Call successful
Does not wish to fill out VAERS report
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Survey response — day 21, dose 3
MedDRA: Pneumonia — Feeling: Fair · 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 have pneumonia.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-11-17
Call 1 — Could Not Reach Participant
2021-11-22
Survey response — day 28, dose 3
MedDRA: Bronchitis, Dyspnoea, Hospitalisation, Pneumonia, Unevaluable event — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Pneumonia and bronchitis. In hospital for 3 days, difficulty breathing. · Healthcare visit (other): Follow-up with Dr tomorrow

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Report sent to call center — day 28, 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 · Hospitalization · 1 call case(s)
2021-11-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-29
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Survey response — 3 months, dose 3
MedDRA: Malaise, SARS-CoV-2 test negative, Viral sinusitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: A new virus set in and has settled in my sinuses. Seemed to have the symptoms of Omicron in the beginning but I tested negative.

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Dose 4 — Moderna
2022-04-14
Health check-in — day 7, dose 4
Feeling: Good · Site: Redness, Swelling, Itching · Fatigue or tiredness

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

Adult check-in
2022-04-22
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-29
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-24	Moderna
3	2021-10-25	Moderna	No
4	2022-04-01	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — day 21, dose 1

2021-02-16

Symptoms: Roaring in my ears. Sinuses feel full, but not sick.

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): My normal temp is 97.5

Release 10 — days 1–6 daily, dose 3

2021-10-28

Systemic reaction (other): Have small a couple blisters on top of red swollen area

Release 10 — day 7, dose 3

2021-11-03

Systemic reaction (other): ER Monday for severe pain &blood in stool they said I had pneumonia & infection in lrg intestine

Healthcare visit (other): Pneumonia & infection in large intestine

Release 10 — day 21, dose 3

2021-11-15

Symptoms: I have pneumonia.

Release 10 — day 28, dose 3

2021-11-22

Symptoms: Pneumonia and bronchitis. In hospital for 3 days, difficulty breathing.

Healthcare visit (other): Follow-up with Dr tomorrow

Release 11 — 3 months, dose 3

2022-01-24

Symptoms: A new virus set in and has settled in my sinuses. Seemed to have the symptoms of Omicron in the beginning but I tested negative.

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	Large intestine infection	·	·	✓
HCVO	Pneumonia	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Bronchitis	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Malaise	·	·	✓
SD	Pneumonia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinus congestion	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SD	Viral sinusitis	·	·	✓
SRO	Blister	·	·	✓
SRO	Emergency care	·	·	✓
SRO	Erythema	·	·	✓
SRO	Haematochezia	·	·	✓
SRO	Large intestine infection	·	·	✓
SRO	Pain	·	·	✓
SRO	Pneumonia	·	·	✓
SRO	Swelling	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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