4XM-89964-37277
4 vaccinations
12 coded responses
42 check-ins
12 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 021 / MA
- Registered
- 2021-04-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
NG5-91034-36142
Child or adolescent in my care · Female · 2021-11-09
Timeline
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2021-04-13
Registered in v-safe
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2021-04-13
Dose 1 — Moderna
- 2021-04-13
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2021-04-14
Survey response — days 1–6 daily, dose 1MedDRA: Headache — Feeling: Good · Site: PainFree text: I had a little headache last night but it was relieved by ZomigMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-15
Survey response — days 1–6 daily, dose 1MedDRA: Contusion — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Got a bruise on one finger from picking up a heavy shopping bag. Weird thing to get a bruise from.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-16
Survey response — days 1–6 daily, dose 1MedDRA: Pre-existing disease — Feeling: Poor · Chills, Headache, Fatigue or tiredness · Be unable to workFree text: I also suffer frequent migraines so its unclear if this was the shots faultMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-17
Survey response — days 1–6 daily, dose 1MedDRA: Headache, Pre-existing disease — Feeling: Good · HeadacheFree text: I suffer from migraines so the headache is probably not from the shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-18
Survey response — days 1–6 daily, dose 1MedDRA: Pre-existing disease — Feeling: Good · HeadacheFree text: I suffer from migraines generallyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-19
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2021-04-20
Survey response — day 7, dose 1MedDRA: Migraine — Feeling: Good · HeadacheFree text: Migraine, periodMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-27
- 2021-05-04
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2021-05-11
Dose 2 — Moderna
- 2021-05-11
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2021-05-12
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to workAdult check-in
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2021-05-13
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
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2021-05-14
Survey response — days 1–6 daily, dose 2MedDRA: Migraine — Feeling: Good · Headache, Fatigue or tirednessFree text: Probably a migraineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-15
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2021-05-16
Health check-in — days 1–6 daily, dose 2Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-05-17
- 2021-05-18
- 2021-05-25
- 2021-06-01
- 2021-06-08
- 2021-06-15
- 2021-06-22
- 2021-08-10
- 2021-11-09
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2021-11-18
Dose 3 — Moderna
- 2021-11-20
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2021-11-21
Survey response — days 1–6 daily, dose 3MedDRA: Migraine, Pre-existing disease — Feeling: Fair · Site: Pain · HeadacheFree text: I get migraines 9-13 days a month so this may or may not be related to the shotMedDRA releases: 2024-11 · check-in free text available
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2021-11-22
Survey response — days 1–6 daily, dose 3MedDRA: Migraine — Feeling: Fair · Headache, NauseaFree text: These symptoms are consistent with migraineMedDRA releases: 2024-11 · check-in free text available
- 2021-11-23
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2021-11-24
Survey response — days 1–6 daily, dose 3MedDRA: Migraine — Feeling: Fair · Headache, Fatigue or tirednessFree text: I've been having a 2 week migraine I'm not sure it's shot relatedMedDRA releases: 2024-11 · check-in free text available
- 2021-11-25
- 2021-12-02
- 2021-12-11
- 2021-12-16
- 2021-12-23
- 2021-12-30
- 2022-02-17
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2022-05-19
Survey response — 6 months, dose 3MedDRA: Influenza, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I had suspected Flu A last week. My daughter who was also sick tested positive for Flu A and we both repeatedly tested negative for Covid.MedDRA releases: 2024-11 · check-in free text available
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2022-09-07
Dose 4 — Moderna
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2022-10-11
Survey response — day 28, dose 4MedDRA: COVID-19, Dyspepsia, Emergency care — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visitFree text: I have daily heartburn since my Covid infection in May. I am taking omeprazole now. I went to the ER for what turned out to be severe heartburn.MedDRA releases: 2024-11 · check-in free text available
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2022-10-11
Report sent to call center — day 28, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
- 2022-10-12
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2022-10-12
Call successfulParticipant prefers to complete VAERS report online
- 2022-10-19
- 2022-12-09
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-13 | Moderna | |
| 2 | 2021-05-11 | Moderna | |
| 3 | 2021-11-18 | Moderna | No |
| 4 | 2022-09-07 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): I had a little headache last night but it was relieved by Zomig
Systemic reaction (other): Got a bruise on one finger from picking up a heavy shopping bag. Weird thing to get a bruise from.
Systemic reaction (other): I also suffer frequent migraines so its unclear if this was the shots fault
Systemic reaction (other): I suffer from migraines so the headache is probably not from the shot
Systemic reaction (other): I suffer from migraines generally
Release 7 — day 7, dose 1
Systemic reaction (other): Migraine, period
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Probably a migraine
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): I get migraines 9-13 days a month so this may or may not be related to the shot
Systemic reaction (other): These symptoms are consistent with migraine
Systemic reaction (other): I've been having a 2 week migraine I'm not sure it's shot related
Release 11 — 6 months, dose 3
Symptoms: I had suspected Flu A last week. My daughter who was also sick tested positive for Flu A and we both repeatedly tested negative for Covid.
Release 12 — day 28, dose 4
Symptoms: I have daily heartburn since my Covid infection in May. I am taking omeprazole now. I went to the ER for what turned out to be severe heartburn.
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 | COVID-19 | · | · | ✓ |
| SD | Dyspepsia | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Contusion | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Migraine | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release