5HA-31132-67205

2 vaccinations 6 coded responses 26 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 123 / NY
Registered: 2021-01-05

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

2021-01-05
Registered in v-safe
2021-01-05
Dose 1 — Moderna
2021-01-05
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain, Swelling · Headache, Joint pains

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-06
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

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

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Survey response — day 7, dose 1
MedDRA: Labyrinthitis, Nausea, Vertigo — Feeling: Poor · Nausea · Be unable to do your normal daily activities

Free text: Labarynthitis or vertigo..was trying not to vomit..room was spinning while i was at work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-19
Survey response — day 14, dose 1
MedDRA: Blood urine present, Cystitis, Nausea, Vertigo — Feeling: Fair · Be unable to do your normal daily activities

Free text: Had an isolated incident of vertigo with nausea..no apparent reason..10 days after receiving thd vaccine..also had a sudden bladdwr infection. Blood in urine..wth is this rat poison??

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-02
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-16
Survey response — day 14, dose 2
MedDRA: Asthma, Burning sensation, Chest pain, Cough, Pre-existing disease, Self-medication — Feeling: Good

Free text: Had a severe burning dry cough last night...i normally have my asthma in control but last night my chest burned & couldnt stop coughing. Had to take cough medicine & it went away..weird!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
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: Good

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

Adult check-in
2022-02-02
Survey response — 12 months, dose 2
MedDRA: Brain fog, COVID-19, Chills, Fatigue, Headache, Pain, Pyrexia, SARS-CoV-2 test positive, Sinus pain — Feeling: Good · 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: Symptoms: Had COVID, positive PCR test..fever, chills, headache, fatigue, severe body aches, brain fog, sinus pain · Healthcare visit (other): Positive PCR at COVID checkpoint at Ellis hospital

MedDRA releases: 2024-11 · check-in free text available
2022-02-02
Report sent to call center — 12 months, 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)
2022-02-03
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-05	Moderna
2	2021-02-02	Moderna

Call center

3 call center cases

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

See the call center timeline

Free text

Release 1 — day 7, dose 1

2021-01-12

Systemic reaction (other): Labarynthitis or vertigo..was trying not to vomit..room was spinning while i was at work

Release 2 — day 14, dose 1

2021-01-19

Symptoms: Had an isolated incident of vertigo with nausea..no apparent reason..10 days after receiving thd vaccine..also had a sudden bladdwr infection. Blood in urine..wth is this rat poison??

Release 3 — days 1–6 daily, dose 2

2021-02-03

Systemic reaction (other): Fever

2021-02-06

Systemic reaction (other): Dizziness

Release 4 — day 14, dose 2

2021-02-16

Symptoms: Had a severe burning dry cough last night...i normally have my asthma in control but last night my chest burned & couldnt stop coughing. Had to take cough medicine & it went away..weird!!

Release 11 — 12 months, dose 2

2022-02-02

Symptoms: Had COVID, positive PCR test..fever, chills, headache, fatigue, severe body aches, brain fog, sinus pain

Healthcare visit (other): Positive PCR at COVID checkpoint at Ellis hospital

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	SARS-CoV-2 test positive	·	·	✓
SD	Asthma	✓	✓	✓
SD	Blood urine present	✓	✓	✓
SD	Brain fog	·	·	✓
SD	Burning sensation	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Chills	·	·	✓
SD	Cough	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Cystitis	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Nausea	✓	✓	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Self-medication	✓	✓	✓
SD	Sinus pain	·	·	✓
SD	Vertigo	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Labyrinthitis	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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