4T3-32979-20559

3 vaccinations 11 coded responses 20 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 080 / NJ
Registered: 2021-03-16

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

2021-02-13
Dose 1 — Moderna
2021-03-14
Dose 2 — Moderna
2021-03-16
Registered in v-safe
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Renal pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Kidney pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Sensitivity to weather change, Sinus headache — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Sinus headache , its been raining all day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache

Adult check-in
2021-03-21
Survey response — day 7, dose 2
MedDRA: Headache — Feeling: Poor · Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Had headache EVERY DAY since having Covid . Got worse since shots . I have history of migraine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — day 14, dose 2
MedDRA: COVID-19, Dizziness, Headache, Heart rate increased, Office visit, Sinus disorder, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Have been experiencing bad headaches Also some sinus issues Dizziness Have had pulse ox and rapid heart beat since contracting Covid 11/16/2020 but increasingly worse . Went back to Cardiologist . · Healthcare visit (other): Had appt and have another one coming up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-04
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-11
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-18
Survey response — day 35, dose 2
MedDRA: Headache, Office visit, Palpitations — Feeling: Good

Free text: Still having low pulse ox issues and racing heart on and off since actual COVID .. ( not from vaccine ) had to see a Cardiologist Headache worse since vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-15
Survey response — 3 months, dose 2
MedDRA: Dyspnoea, Heart rate increased, Migraine, Office visit — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Fast Heart rate Trouble breathing More frequent migraines · Healthcare visit (other): Heart specialist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call successful
Does not wish to fill out VAERS report
2021-09-02
Dose 3 — Moderna
2021-09-13
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-09-13
Survey response — day 7, dose 3
MedDRA: Back pain, Neck pain, Pain, Sinus disorder — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Sinus issues, burning pain neck and back

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-09-25
Survey response — day 21, dose 3
MedDRA: Condition aggravated, Pre-existing disease, Tachycardia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Cardio issues again .. have had them on and off since getting Covid 11/20 ( tachycardia, low pulse ox) . Better the last few days .

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-10-07
Survey response — day 35, dose 3
MedDRA: Oxygen saturation abnormal, Sinus disorder, Tremor — Feeling: Poor · Be unable to do your normal daily activities

Free text: Pulse ox issues Shaky Sinus issues

MedDRA releases: 2024-11 · check-in free text available
2021-10-17
Survey response — day 42, dose 3
MedDRA: COVID-19, Chest discomfort, Malaise, Oxygen saturation decreased, Palpitations — Feeling: Fair

Free text: Chest pressure, heart palpitations, low pulse ox I haven't felt good since getting actual Covid virus ( not the vaccine)

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-03-08
Survey response — 6 months, dose 3
MedDRA: COVID-19, Chest pain, Office visit, Oxygen saturation decreased — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Additional chest pains , low pulse oxygen alerts . These have been bad since getting actual Covid in November 2020 not from the vaccines. · Healthcare visit (other): Cardiologist

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-09
Call 1 — Left Voicemail
2022-03-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-14	Moderna
3	2021-09-02	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): Kidney pain

2021-03-18

Systemic reaction (other): Sinus headache , its been raining all day

Release 6 — day 7, dose 2

2021-03-21

Systemic reaction (other): Had headache EVERY DAY since having Covid . Got worse since shots . I have history of migraine

Release 6 — day 14, dose 2

2021-03-28

Symptoms: Have been experiencing bad headaches Also some sinus issues Dizziness Have had pulse ox and rapid heart beat since contracting Covid 11/16/2020 but increasingly worse . Went back to Cardiologist .

Healthcare visit (other): Had appt and have another one coming up

Release 7 — day 35, dose 2

2021-04-18

Symptoms: Still having low pulse ox issues and racing heart on and off since actual COVID .. ( not from vaccine ) had to see a Cardiologist Headache worse since vaccine

Release 9 — 3 months, dose 2

2021-06-15

Symptoms: Fast Heart rate Trouble breathing More frequent migraines

Healthcare visit (other): Heart specialist

Release 9 — day 7, dose 3

2021-09-13

Systemic reaction (other): Sinus issues, burning pain neck and back

Release 9 — day 21, dose 3

2021-09-25

Symptoms: Cardio issues again .. have had them on and off since getting Covid 11/20 ( tachycardia, low pulse ox) . Better the last few days .

Release 10 — day 35, dose 3

2021-10-07

Symptoms: Pulse ox issues Shaky Sinus issues

Release 10 — day 42, dose 3

2021-10-17

Symptoms: Chest pressure, heart palpitations, low pulse ox I haven't felt good since getting actual Covid virus ( not the vaccine)

Release 11 — 6 months, dose 3

2022-03-08

Symptoms: Additional chest pains , low pulse oxygen alerts . These have been bad since getting actual Covid in November 2020 not from the vaccines.

Healthcare visit (other): Cardiologist

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	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Chest pain	·	·	✓
SD	Condition aggravated	·	·	✓
SD	COVID-19	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Malaise	·	·	✓
SD	Migraine	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Oxygen saturation abnormal	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Palpitations	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Sinus disorder	✓	✓	✓
SD	Tachycardia	·	·	✓
SD	Tremor	·	·	✓
SRO	Back pain	·	·	✓
SRO	Headache	✓	✓	✓
SRO	Neck pain	·	·	✓
SRO	Pain	·	·	✓
SRO	Renal pain	✓	✓	✓
SRO	Sensitivity to weather change	✓	✓	✓
SRO	Sinus disorder	·	·	✓
SRO	Sinus headache	✓	✓	✓

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