5EK-25865-01238

4 vaccinations 15 coded responses 40 check-ins 14 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 112 / NY
Registered: 2021-02-14

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-14
Registered in v-safe
2021-02-14
Dose 1 — Moderna
2021-02-14
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Nausea

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Exposure to SARS-CoV-2 — Feeling: Good · Nausea

Free text: I was exposed to COVID-19 on 2/17/21 dont know what to do.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-21
Survey response — day 7, dose 1
MedDRA: Abdominal pain lower — Feeling: Good · Nausea, Diarrhea, Abdominal pain · Be unable to work

Free text: Extreme lower abdominal pain .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-14
Dose 2 — Moderna
2021-03-14
Survey response — day 0, dose 2
MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Runny Nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Vomiting, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — 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

Free text: Is this normal?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Fatigue or tiredness

Free text: Light head

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-28
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-04
Survey response — day 21, dose 2
MedDRA: Cough, Headache, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headaches and cough and fever.

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

Free text: I have headaches and high fevers that last a day or two days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-25
Survey response — day 42, dose 2
MedDRA: Fatigue, Headache, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: The headaches for three days . Tiredness. · Healthcare visit (other): Went to my primary physician.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tiredness, Nausea

Adult check-in
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Swelling · Fever

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness · None

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-11-18
Survey response — day 21, dose 3
MedDRA: Cough, Dyspnoea, Pain, Pyrexia — Feeling: Poor · Be unable to work or attend school

Free text: 11/12/21 Started coughing body aches fever. Shortness of breath.

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Survey response — day 35, dose 3
MedDRA: Cough, Pyrexia — Feeling: Good

Free text: Coughing slight fever.

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Health check-in — day 42, dose 3
Feeling: Good

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

Adult check-in
2022-04-07
Call successful
Does not wish to fill out VAERS report
2022-04-29
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-27
Dose 4 — Moderna
2022-09-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Fever · Headache · Be unable to work or attend school

Adult check-in
2022-09-30
Survey response — days 1–6 daily, dose 4
MedDRA: Dysgeusia, Feeling abnormal, Sluggishness — Feeling: Fair · Site: Pain, Swelling

Free text: This booster shot my body did not agree with it. I feel sluggish and just weird. My mouth and throat taste metallic.

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-18
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-03
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-27
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-28
Survey response — 6 months, dose 4
MedDRA: Cough, Rhinorrhoea — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-03-28
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-03-29
Call 1 — Requested Callback
2023-03-29
Callback requested for
03:00PM ET
2023-03-29
Call successful
Completed over the phone

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-14	Moderna
2	2021-03-14	Moderna
3	2021-10-27	Moderna	No
4	2022-09-27	Moderna	No

Call center

2 call center cases

2 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-19

Systemic reaction (other): I was exposed to COVID-19 on 2/17/21 dont know what to do.

Release 4 — day 7, dose 1

2021-02-21

Systemic reaction (other): Extreme lower abdominal pain .

Release 5 — day 0, dose 2

2021-03-14

Systemic reaction (other): Runny Nose

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): Dizzy

2021-03-16

Systemic reaction (other): Is this normal?

2021-03-18

Systemic reaction (other): Light headed

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): Light head

Release 6 — day 21, dose 2

2021-04-04

Symptoms: Headaches and cough and fever.

Release 7 — day 28, dose 2

2021-04-11

Symptoms: I have headaches and high fevers that last a day or two days.

Release 7 — day 42, dose 2

2021-04-25

Symptoms: The headaches for three days . Tiredness.

Healthcare visit (other): Went to my primary physician.

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): Dizziness

Release 10 — day 21, dose 3

2021-11-18

Symptoms: 11/12/21 Started coughing body aches fever. Shortness of breath.

Release 10 — day 35, dose 3

2021-12-01

Symptoms: Coughing slight fever.

Release 12 — days 1–6 daily, dose 4

2022-09-30

Systemic reaction (other): This booster shot my body did not agree with it. I feel sluggish and just weird. My mouth and throat taste metallic.

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	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pain	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SRO	Abdominal pain lower	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysgeusia	·	·	✓
SRO	Exposure to SARS-CoV-2	✓	✓	✓
SRO	Feeling abnormal	·	·	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sluggishness	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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