5MA-17990-75238

4 vaccinations 18 coded responses 44 check-ins 17 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 919 / CA
Registered: 2021-02-11

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

2021-01-25
Dose 1 — Moderna
2021-02-11
Registered in v-safe
2021-02-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-01
Dose 2 — Moderna
2021-03-01
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · 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

Adult check-in
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Pain — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Not inter in eating. Pain on other side ( old yellow fever shot)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Hypersensitivity — Feeling: Good · Fatigue or tiredness

Free text: Allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Fatigue or tiredness

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinorrhoea — Feeling: Good · Fatigue or tiredness

Free text: Runny nose.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — day 7, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-29
Survey response — day 28, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue. Slept 4 hours midday on Sanday then all night last night and still tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — day 35, dose 2
MedDRA: Pre-existing disease, Sinus disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Horrible sinus/ allergies. Ive taken a lot of herbs and mushrooms to improve my immune system. Have I done this to myself?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — day 42, dose 2
MedDRA: Pre-existing disease — Feeling: Good

Free text: Allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Survey response — 3 months, dose 2
MedDRA: Ear discomfort — Feeling: Good

Free text: My left ear feels clogged and I hear pounding in it when I burp or yawn ( after endoscopy). I have had gerd for most of the last several years

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-01
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-31
Dose 3 — Moderna
2021-10-31
Survey response — day 0, dose 3
MedDRA: Dizziness — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: A little light headed

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
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, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

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

Adult check-in
2021-11-05
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: I was tired for a long time after last vax, also

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Flatulence, Gastrooesophageal reflux disease — Feeling: Good · Fatigue or tiredness

Free text: A little gassy as I was with first two shots. ( GERD pretty bad)

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

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

Adult check-in
2021-11-21
Health check-in — day 21, dose 3
Feeling: Good

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

Adult check-in
2021-12-05
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-12
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-30
Survey response — 3 months, dose 3
MedDRA: Cerebrovascular accident — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Stroke on 1/1

MedDRA releases: 2024-11 · check-in free text available
2022-01-30
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-02
Call 1 — Left Voicemail
2022-05-01
Survey response — 6 months, dose 3
MedDRA: Cerebrovascular accident — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Stroke on 1/1/22

MedDRA releases: 2024-11 · check-in free text available
2022-05-01
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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-02
Call successful
Participant prefers to complete VAERS report online
2022-05-02
Call successful
Participant prefers to complete VAERS report online
2022-05-10
Dose 4 — Moderna
2022-05-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-17
Health check-in — day 7, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-24
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-06-02
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-06-07
Survey response — day 28, dose 4
MedDRA: Furuncle — Feeling: Good

Free text: Boil

MedDRA releases: 2024-11 · check-in free text available
2022-06-14
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-21
Survey response — day 42, dose 4
MedDRA: Fatigue, Furuncle — Feeling: Fair

Free text: Boil. Fatigue.

MedDRA releases: 2024-11 · check-in free text available
2022-08-12
Survey response — 3 months, dose 4
MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend school

Free text: Had COVID in Ireland

MedDRA releases: 2024-11 · check-in free text available
2022-11-08
Survey response — 6 months, dose 4
MedDRA: Fall, Triple negative breast cancer — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Diagnosed with triple negative breast cancer · Healthcare visit (other): Also had a fall no bones broken

MedDRA releases: 2024-11 · check-in free text available
2022-11-08
Report sent to call center — 6 months, 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)
2022-11-09
Call successful
Not applicable - Accidental Reporting
2023-05-10
Survey response — 12 months, dose 4
MedDRA: Breast cancer, Breast conserving surgery, COVID-19, Cerebrovascular accident, Chemotherapy, Surgery — 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 · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-05-10
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2023-05-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-03-01	Moderna
3	2021-10-31	Moderna	No
4	2022-05-10	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Not inter in eating. Pain on other side ( old yellow fever shot)

Release 5 — days 1–6 daily, dose 2

2021-03-05

Systemic reaction (other): Allergies

2021-03-07

Systemic reaction (other): Runny nose.

Release 5 — day 7, dose 2

2021-03-08

Systemic reaction (other): Allergies

Release 6 — day 28, dose 2

2021-03-29

Symptoms: Fatigue. Slept 4 hours midday on Sanday then all night last night and still tired

Release 6 — day 35, dose 2

2021-04-05

Symptoms: Horrible sinus/ allergies. Ive taken a lot of herbs and mushrooms to improve my immune system. Have I done this to myself?

Release 7 — day 42, dose 2

2021-04-12

Symptoms: Allergies

Release 8 — 3 months, dose 2

2021-05-31

Symptoms: My left ear feels clogged and I hear pounding in it when I burp or yawn ( after endoscopy). I have had gerd for most of the last several years

Release 10 — day 0, dose 3

2021-10-31

Systemic reaction (other): A little light headed

Release 10 — days 1–6 daily, dose 3

2021-11-05

Systemic reaction (other): I was tired for a long time after last vax, also

2021-11-06

Systemic reaction (other): A little gassy as I was with first two shots. ( GERD pretty bad)

Release 11 — 3 months, dose 3

2022-01-30

Symptoms: Stroke on 1/1

Release 11 — 6 months, dose 3

2022-05-01

Symptoms: Stroke on 1/1/22

Release 11 — day 28, dose 4

2022-06-07

Symptoms: Boil

Release 12 — day 42, dose 4

2022-06-21

Symptoms: Boil. Fatigue.

Release 12 — 3 months, dose 4

2022-08-12

Symptoms: Had COVID in Ireland

Release 12 — 6 months, dose 4

2022-11-08

Symptoms: Diagnosed with triple negative breast cancer

Healthcare visit (other): Also had a fall no bones broken

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	Chemotherapy	·	·	✓
HCVO	Fall	·	·	✓
HCVO	Surgery	·	·	✓
SD	Breast cancer	·	·	✓
SD	Breast conserving surgery	·	·	✓
SD	Cerebrovascular accident	·	·	✓
SD	Chemotherapy	·	·	✓
SD	COVID-19	·	·	✓
SD	Ear discomfort	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Furuncle	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinus disorder	✓	✓	✓
SD	Triple negative breast cancer	·	·	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Flatulence	·	·	✓
SRO	Gastrooesophageal reflux disease	·	·	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓

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