5R4-13033-18445

3 vaccinations 13 coded responses 31 check-ins 13 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 722 / AR
Registered: 2021-02-23

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

2021-01-28
Dose 1 — Moderna
2021-02-23
Registered in v-safe
2021-02-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Redness, Swelling · Muscle or body aches

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Redness · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Redness, Itching · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Redness · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 7, dose 2
MedDRA: Dyspnoea — Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 14, dose 2
MedDRA: Dyspnoea, Hospitalisation, Hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Been in hospital the last four days. Symptoms include shortness of breath caused by any exertion and blood pressure to go to 200 +. Blood oxygen is low.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Have been diagnosed with A-Fib.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-13
Call 1 — Left Voicemail
2021-10-13
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-26
Dose 3 — Moderna
2021-10-26
Survey response — day 0, dose 3
MedDRA: Adverse reaction, Pyrexia — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: All Symptoms lasted 2 days. Fever was 100.9

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Heart rate decreased — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness · 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: Apple Watch alerted me at 11:00 a.m. that my heart rate was too low.

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-10-29
Call 1 — Could Not Reach Participant
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-03
Call successful
Does not wish to fill out VAERS report
2021-11-11
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-23
Survey response — day 28, dose 3
MedDRA: Unevaluable event — Feeling: Poor · 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: Mostly urological nothing to do with vaccines or Covid related hey I'm OLD!!!

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Report sent to call center — day 28, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-29
Call 1 — Left Voicemail
2021-12-01
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Brain fog, Disturbance in attention, Dizziness, Dyspnoea exertional, Fatigue, Memory impairment, Mobility decreased, Rash pruritic, Skin burning sensation — Feeling: Poor · Be unable to do your normal daily activities

Free text: New for March and April a fiery itchy rash on my left side. Fatigue, mobility problems, shortness of breath on exertion, brain fog, memory problems, inability to concentrate, dizziness.

MedDRA releases: 2024-11 · check-in free text available
2022-10-26
Survey response — 12 months, dose 3
MedDRA: Asthenia, Muscular weakness, Therapeutic response unexpected — Feeling: Good · Be unable to do your normal daily activities

Free text: Short of breath symptoms GONE after 3 years!!! ? but back and legs are very weak!!! BUT I'm 90 , now- Have to rest after slightest exertion. Hope to get stronger. Have had all vaccinations.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-02-25	Moderna
3	2021-10-26	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): No

2021-02-27

Systemic reaction (other): No

2021-03-01

Systemic reaction (other): No

2021-03-02

Systemic reaction (other): No

2021-03-03

Systemic reaction (other): No

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): Shortness of breath

Release 5 — day 14, dose 2

2021-03-11

Symptoms: Been in hospital the last four days. Symptoms include shortness of breath caused by any exertion and blood pressure to go to 200 +. Blood oxygen is low.

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: Have been diagnosed with A-Fib.

Release 10 — day 0, dose 3

2021-10-26

Systemic reaction (other): All Symptoms lasted 2 days. Fever was 100.9

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Apple Watch alerted me at 11:00 a.m. that my heart rate was too low.

Release 10 — day 28, dose 3

2021-11-23

Symptoms: Mostly urological nothing to do with vaccines or Covid related hey I'm OLD!!!

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: New for March and April a fiery itchy rash on my left side. Fatigue, mobility problems, shortness of breath on exertion, brain fog, memory problems, inability to concentrate, dizziness.

Release 12 — 12 months, dose 3

2022-10-26

Symptoms: Short of breath symptoms GONE after 3 years!!! ? but back and legs are very weak!!! BUT I'm 90 , now- Have to rest after slightest exertion. Hope to get stronger. Have had all vaccinations.

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
SD	Asthenia	·	·	✓
SD	Brain fog	·	·	✓
SD	Disturbance in attention	·	·	✓
SD	Dizziness	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Dyspnoea exertional	·	·	✓
SD	Fatigue	·	·	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Memory impairment	·	·	✓
SD	Mobility decreased	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash pruritic	·	·	✓
SD	Skin burning sensation	·	·	✓
SD	Therapeutic response unexpected	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Heart rate decreased	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pyrexia	·	·	✓

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