4ZX-12661-68889

5 vaccinations 18 coded responses 59 check-ins 17 free-text entries 6 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 670 / KS
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-06
Survey response — days 1–6 daily, dose 1
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Ringing ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Nausea

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-11
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-09
Survey response — day 7, dose 2
MedDRA: Hypersomnia, Immunisation, Impaired work ability, Pyrexia — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: I received the vaccine booster on 2/2. I had a fever on 2/4 and slept most of that day. I missed work.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-23
Survey response — day 21, dose 2
MedDRA: Dizziness, Headache, Nausea — Feeling: Fair · Be unable to work

Free text: Dizziness, nausea, headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 28, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Headache

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

Adult check-in
2021-03-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-03
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Tachycardia — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tachycardia 100-130

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Tachycardia — Feeling: Fair · Headache, Muscle or body aches

Free text: Still tachy heart rate

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-06
Health check-in — day 7, dose 3
Feeling: Fair · Headache, Muscle or body aches, Nausea

Adult check-in
2021-11-12
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-19
Survey response — day 21, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: GU issue - do not think it is vaccine related

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-22
Call successful
Not applicable - Accidental Reporting
2021-11-26
Survey response — day 28, dose 3
MedDRA: Cough, Headache, Oropharyngeal pain, Sinus congestion — Feeling: Poor

Free text: Sore throat Headache Sinus congestion Cough No fever

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Survey response — day 35, dose 3
MedDRA: Cough, Headache, Respiratory tract congestion — Feeling: Fair

Free text: Ongoing headache, congestion and cough. No fever

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-28
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Dizziness, Fatigue — Feeling: Fair

Free text: Generalized fatigue. Occasional dizziness.

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Dose 4 — Moderna
2022-05-21
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-05-22
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-05-23
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2022-05-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-25
Survey response — days 1–6 daily, dose 4
MedDRA: Dyspnoea, Unevaluable event — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Feel SOB/ can't get a deep breath · Healthcare visit (other): I've called for an office visit

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Report sent to call center — days 1–6 daily, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-26
Survey response — days 1–6 daily, dose 4
MedDRA: Chest discomfort — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Chest pressure

MedDRA releases: 2024-11 · check-in free text available
2022-05-26
Report sent to call center — days 1–6 daily, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-26
Call 1 — Left Voicemail
2022-05-27
Survey response — day 7, dose 4
MedDRA: Adverse reaction, Office visit — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work or attend school

Free text: I have received medical care and the symptoms were not considered related to the vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Call successful
Not applicable - Accidental Reporting
2022-05-27
Call successful
Not applicable - Accidental Reporting
2022-06-03
Survey response — day 14, dose 4
MedDRA: Adverse reaction — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Physicians do not think the symptoms are related to the vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-06-03
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-06-06
Call successful
Not applicable - Accidental Reporting
2022-06-10
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-06-17
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-24
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-07-01
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-21
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-14
Dose 5 — Moderna
2022-10-15
Survey response — days 1–6 daily, dose 5
MedDRA: Pyrexia, Self-medication — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: The fever was a couple hours after fever reducing medication g

MedDRA releases: 2024-11 · check-in free text available
2022-10-16
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-10-17
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Joint pains, Fatigue or tiredness

Adult check-in
2022-10-18
Survey response — days 1–6 daily, dose 5
MedDRA: Feeling hot, Headache, Nausea — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Nausea

Free text: The headache, nausea, and feeling feverish occurred at the same time but temp wasn't elevated.

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2022-10-20
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2022-10-21
Health check-in — day 7, dose 5
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-10-28
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-11-04
Survey response — day 21, dose 5
MedDRA: Dizziness, Headache, Hypertension, Nausea — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Hypertension Headaches Nausea Dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-11-04
Report sent to call center — day 21, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-08
Call 1 — Left Voicemail
2022-11-11
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-11-18
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-11-25
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2023-01-13
Survey response — 3 months, dose 5
MedDRA: Hypertension — Feeling: Fair

MedDRA releases: 2024-11
2023-04-14
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-02	Moderna
3	2021-10-29	Moderna	No
4	2022-05-20	Moderna	No
5	2022-10-14	Moderna	No

Call center

6 call center cases

4 successful · 1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-06

Systemic reaction (other): Ringing ears

Release 3 — day 7, dose 2

2021-02-09

Systemic reaction (other): I received the vaccine booster on 2/2. I had a fever on 2/4 and slept most of that day. I missed work.

Release 4 — day 21, dose 2

2021-02-23

Symptoms: Dizziness, nausea, headache

Release 4 — day 28, dose 2

2021-03-02

Symptoms: Headache

Release 10 — days 1–6 daily, dose 3

2021-10-31

Systemic reaction (other): Tachycardia 100-130

2021-11-02

Systemic reaction (other): Still tachy heart rate

Release 10 — day 21, dose 3

2021-11-19

Symptoms: GU issue - do not think it is vaccine related

Release 10 — day 28, dose 3

2021-11-26

Symptoms: Sore throat Headache Sinus congestion Cough No fever

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Ongoing headache, congestion and cough. No fever

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Generalized fatigue. Occasional dizziness.

Release 11 — days 1–6 daily, dose 4

2022-05-25

Systemic reaction (other): Feel SOB/ can't get a deep breath

Healthcare visit (other): I've called for an office visit

2022-05-26

Systemic reaction (other): Chest pressure

Release 11 — day 7, dose 4

2022-05-27

Systemic reaction (other): I have received medical care and the symptoms were not considered related to the vaccine.

Release 11 — day 14, dose 4

2022-06-03

Symptoms: Physicians do not think the symptoms are related to the vaccine.

Release 12 — days 1–6 daily, dose 5

2022-10-15

Systemic reaction (other): The fever was a couple hours after fever reducing medication g

2022-10-18

Systemic reaction (other): The headache, nausea, and feeling feverish occurred at the same time but temp wasn't elevated.

Release 12 — day 21, dose 5

2022-11-04

Symptoms: Hypertension Headaches Nausea Dizziness

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	Unevaluable event	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypertension	·	·	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Feeling hot	·	·	✓
SRO	Headache	·	·	✓
SRO	Hypersomnia	✓	✓	✓
SRO	Immunisation	○	✓	○
SRO	Impaired work ability	✓	·	✓
SRO	Nausea	·	·	✓
SRO	Office visit	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	·	·	✓
SRO	Tachycardia	·	·	✓
SRO	Tinnitus	✓	✓	✓

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