5H3-64740-91209

2 vaccinations 6 coded responses 24 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 984 / WA
Registered: 2021-05-12

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
1424140 (opens in a new window)	high	9 / 11	—	1 of 6 VAERS symptoms	same dose (2)	WA matches	2021-06-09 / 2021-06-09 / 2021-06-24 received 15 days after the last call	case 773083

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

2021-05-12
Registered in v-safe
2021-05-12
Dose 1 — Moderna
2021-05-12
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-26
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-06-02
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-06-09
Dose 2 — Moderna
2021-06-09
Survey response — day 0, dose 2
MedDRA: Emergency care — Feeling: Good · Site: Pain · Headache, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I blacked out after receiving shot (no place to sit afterwards) and hit my head on the floor of Walgreens. I was taken to ER by fire department.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Report sent to call center — day 0, 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)
2021-06-10
Survey response — days 1–6 daily, dose 2
MedDRA: Headache, Syncope — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: My head is still hurting from fainting after the vaccine (no place to sit and rest)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Survey response — days 1–6 daily, dose 2
MedDRA: Headache — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: My head still really hurts from hitting it on the floor. (No place to sit during observation period. I dropped some papers, picked them up, saw stars and then fainted.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Headache, Immediate post-injection reaction, Syncope — Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: My head hurts really bad today. I fainted after my shot (no place to sit after and I bent over to pick up some papers I dropped).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-14
Survey response — days 1–6 daily, dose 2
MedDRA: Concussion, Office visit — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I found out I have a concussion from blacking out after receiving vaccine (no place to sit and I dropped some papers; when I stood I saw stars then fainted hitting my head and elbow on Walgreens floor). · Healthcare visit (other): Primary care doctor visit - ER follow up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-14
Report sent to call center — days 1–6 daily, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-06-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-06-16
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-06-21
Call 1 — Could Not Reach Participant
2021-06-23
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-06-24
Call 2 — Left Voicemail
2021-06-24
Call successful
Completed over the phone
2021-06-30
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-07-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-21
Survey response — day 42, dose 2
MedDRA: Headache, Pre-existing disease — 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 · Telehealth, virtual health, or email health consultation

Free text: My head has started aching again more than usual. My doctor has referred me for another brain scan to see if my blain has a slow bleed and to the sports medicine concussion team for follow up

MedDRA releases: 2024-11 · check-in free text available
2021-07-21
Report sent to call center — day 42, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-27
Call successful
Participant prefers to complete VAERS report online
2021-09-08
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-12-08
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-12	Moderna
2	2021-06-09	Moderna

Call center

3 call center cases

3 successful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 9 — day 0, dose 2

2021-06-09

Systemic reaction (other): I blacked out after receiving shot (no place to sit afterwards) and hit my head on the floor of Walgreens. I was taken to ER by fire department.

Release 9 — days 1–6 daily, dose 2

2021-06-10

Systemic reaction (other): My head is still hurting from fainting after the vaccine (no place to sit and rest)

2021-06-11

Systemic reaction (other): My head still really hurts from hitting it on the floor. (No place to sit during observation period. I dropped some papers, picked them up, saw stars and then fainted.

2021-06-13

Systemic reaction (other): My head hurts really bad today. I fainted after my shot (no place to sit after and I bent over to pick up some papers I dropped).

2021-06-14

Systemic reaction (other): I found out I have a concussion from blacking out after receiving vaccine (no place to sit and I dropped some papers; when I stood I saw stars then fainted hitting my head and elbow on Walgreens floor).

Healthcare visit (other): Primary care doctor visit - ER follow up

Release 9 — day 42, dose 2

2021-07-21

Symptoms: My head has started aching again more than usual. My doctor has referred me for another brain scan to see if my blain has a slow bleed and to the sports medicine concussion team for follow up

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	Headache	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Concussion	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Syncope	✓	✓	✓

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