58P-22936-38997

4 vaccinations 22 coded responses 46 check-ins 21 free-text entries 7 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 049 / ME
Registered: 2020-12-30

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

Registered dependents

5HZ-13003-25443 Child or adolescent in my care · Female · 2022-09-21

Timeline

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

2020-12-29
Dose 1 — Moderna
2020-12-30
Registered in v-safe
2020-12-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Chills

Adult check-in
2020-12-31
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Fatigue, Pain — Feeling: Good · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Last night temp 100.1, severe fatigue, body aches and chills lasting only 3-4 hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-31
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

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

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-02
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Conjunctivitis, Eyelid rash, Rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash- unlikely related- around eye with mild conjunctivitis and under breast

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-04
Survey response — days 1–6 daily, dose 1
MedDRA: Eyelid rash, Rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash worsening, face, under breast and around eye.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-05
Health check-in — day 7, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-01-12
Survey response — day 14, dose 1
MedDRA: Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Worsening rash on the face and under breast on same side as vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-19
Survey response — day 21, dose 1
MedDRA: Headache, Unevaluable event — Feeling: Fair · 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: Symptoms: Headaches · Healthcare visit (other): Omt

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-26
Dose 2 — Moderna
2021-01-27
Survey response — days 1–6 daily, dose 2
MedDRA: Confusional state, Dyspnoea — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Confusion, shortness of breath, feeling of impending doom

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Lymphadenopathy — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Axillary and cervical lymphadenopathy, dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-02
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Survey response — day 21, dose 2
MedDRA: Conjunctivitis, Rash — Feeling: Good

Free text: I have again developed a Rash on my face and eye plus conjunctivitis on the same side as my vaccine. Again about 2 weeks after the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Call successful
Participant prefers to complete VAERS report online
2021-02-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-27
Survey response — 6 months, dose 2
MedDRA: Adverse reaction, Pregnancy — Feeling: Good

Free text: Pregnancy symptoms only

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-25
Dose 3 — Pfizer-BioNTech
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: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Site: Pain

Free text: Significant tender lymph node swelling in the neck and axillary- golf ball to clementine sized

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Hypoaesthesia, Lymphadenopathy, Physiotherapy — Feeling: Fair · Site: Pain · Headache · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Severe lymphadenopathy leading to hand numbness · Healthcare visit (other): Omt

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-29
Call successful
Does not wish to fill out VAERS report
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Hypoaesthesia, Lymphadenopathy — Feeling: Fair · Site: Pain

Free text: Lymphadenopathy causing left hand numbness- improving

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Muscle or body aches, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: I think these are u related to the shot

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-09
Survey response — day 14, dose 3
MedDRA: Cough, Fatigue, Headache, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: Good

Free text: Caught a cold. Congestion, cough, fatigue headache. Covid negative

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Survey response — day 42, dose 3
MedDRA: Headache — Feeling: Fair

Free text: Headaches

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Survey response — 3 months, dose 3
MedDRA: COVID-19, Malaise — Feeling: Poor · Be unable to work or attend school

Free text: Covid symptoms positive dx

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Survey response — 6 months, dose 3
MedDRA: Anxiety, COVID-19, Delivery, Dyspnoea, Hypoxia, Respiratory symptom — 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 · Hospitalization

Free text: Symptoms: Delivered my baby. Severe respiratory symptoms after delivery for 4 Hours- hypoxia required 8 units oxygen and sob and impending doom sensation. Cta and labs normals. Started resolving at 3 hours. Off oxygen at 4. Believed to be due to covid · Healthcare visit (other): During delivery only

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — 6 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

Hospitalization · 1 call case(s)
2022-04-26
Call successful
Participant prefers to complete VAERS report online
2022-09-20
Dose 4 — Pfizer-BioNTech
2022-09-21
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-23
Survey response — days 1–6 daily, dose 4
MedDRA: Lymphadenopathy, Neuralgia — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Severe axillary and cervical adenopathy causing neuralgias

MedDRA releases: 2024-11 · check-in free text available
2022-09-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache

Adult check-in
2022-09-27
Health check-in — day 7, dose 4
Feeling: Fair · Headache

Adult check-in
2022-10-11
Survey response — day 21, dose 4
MedDRA: Chills, Headache, Pain, Pyrexia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fever, headache, body aches, chills

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Survey response — day 28, dose 4
MedDRA: Cough, Headache, Oropharyngeal pain, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sore throat, cough, congestion, headache

MedDRA releases: 2024-11 · check-in free text available
2022-10-25
Survey response — day 35, dose 4
MedDRA: Cough, Oropharyngeal pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Cough, sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-11-01
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2023-03-23
Survey response — 6 months, dose 4
MedDRA: Gastrointestinal viral infection — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-26	Moderna
3	2021-10-25	Pfizer-BioNTech	No
4	2022-09-20	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2020-12-31	Successful	Participant prefers to complete VAERS report online
2021-01-02	Successful	Participant prefers to complete VAERS report online
2021-01-12	Successful 2021-02-22	Participant prefers to complete VAERS report online
2021-01-19	Successful	Participant prefers to complete VAERS report online
2021-01-27	Successful	Participant prefers to complete VAERS report online
2021-10-28	Successful 2021-10-29	Does not wish to fill out VAERS report
2022-04-25	Successful 2022-04-26	Participant prefers to complete VAERS report online

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-31

Systemic reaction (other): Last night temp 100.1, severe fatigue, body aches and chills lasting only 3-4 hours

2021-01-03

Systemic reaction (other): Rash- unlikely related- around eye with mild conjunctivitis and under breast

2021-01-04

Systemic reaction (other): Rash worsening, face, under breast and around eye.

Release 1 — day 14, dose 1

2021-01-12

Symptoms: Worsening rash on the face and under breast on same side as vaccine

Release 2 — day 21, dose 1

2021-01-19

Symptoms: Headaches

Healthcare visit (other): Omt

Release 2 — days 1–6 daily, dose 2

2021-01-27

Systemic reaction (other): Confusion, shortness of breath, feeling of impending doom

2021-01-28

Systemic reaction (other): Axillary and cervical lymphadenopathy, dizziness

Release 4 — day 21, dose 2

2021-02-16

Symptoms: I have again developed a Rash on my face and eye plus conjunctivitis on the same side as my vaccine. Again about 2 weeks after the vaccine.

Release 9 — 6 months, dose 2

2021-07-27

Symptoms: Pregnancy symptoms only

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Significant tender lymph node swelling in the neck and axillary- golf ball to clementine sized

2021-10-28

Systemic reaction (other): Severe lymphadenopathy leading to hand numbness

Healthcare visit (other): Omt

2021-10-30

Systemic reaction (other): Lymphadenopathy causing left hand numbness- improving

2021-10-31

Systemic reaction (other): I think these are u related to the shot

Release 10 — day 14, dose 3

2021-11-09

Symptoms: Caught a cold. Congestion, cough, fatigue headache. Covid negative

Release 10 — day 42, dose 3

2021-12-06

Symptoms: Headaches

Release 11 — 3 months, dose 3

2022-01-24

Symptoms: Covid symptoms positive dx

Release 11 — 6 months, dose 3

2022-04-25

Symptoms: Delivered my baby. Severe respiratory symptoms after delivery for 4 Hours- hypoxia required 8 units oxygen and sob and impending doom sensation. Cta and labs normals. Started resolving at 3 hours. Off oxygen at 4. Believed to be due to covid

Healthcare visit (other): During delivery only

Release 12 — days 1–6 daily, dose 4

2022-09-23

Systemic reaction (other): Severe axillary and cervical adenopathy causing neuralgias

Release 12 — day 21, dose 4

2022-10-11

Symptoms: Fever, headache, body aches, chills

Release 12 — day 28, dose 4

2022-10-20

Symptoms: Sore throat, cough, congestion, headache

Release 12 — day 35, dose 4

2022-10-25

Symptoms: Cough, sore throat

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	Delivery	·	·	✓
HCVO	Physiotherapy	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Adverse reaction	✓	·	✓
SD	Anxiety	·	·	✓
SD	Chills	·	·	✓
SD	Conjunctivitis	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Delivery	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal viral infection	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypoxia	·	·	✓
SD	Malaise	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pregnancy	✓	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	✓	✓	✓
SD	Respiratory symptom	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Confusional state	✓	✓	✓
SRO	Conjunctivitis	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Eyelid rash	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Neuralgia	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Unevaluable event	·	·	✓

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