5SC-11180-12275

5 vaccinations 16 coded responses 59 check-ins 15 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 980 / WA
Registered: 2021-03-11

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

2021-03-11
Registered in v-safe
2021-03-11
Dose 1 — Moderna
2021-03-11
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — day 7, dose 1
MedDRA: Unevaluable event — Feeling: Good

Free text: Probably unrelated hand pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-08
Dose 2 — Moderna
2021-04-15
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Survey response — day 28, dose 2
MedDRA: Rash, Rash erythematous, Rash pruritic — Feeling: Good

Free text: Rash on left side of my back. Red bumps that itched. This may have been from Shingrix booster immunization on 4/26/2021 (>2 weeks after 2nd Covid immunization-4/8/2021).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-07
Survey response — 6 months, dose 2
MedDRA: Chromaturia, Headache, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Some intermittent low grade fevers/headaches and some dark (brown) urine. Both seemed to have resolved mostly.

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-12
Call successful
Participant prefers to complete VAERS report online
2021-11-02
Dose 3 — Moderna
2021-11-02
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

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

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

Adult check-in
2021-11-05
Survey response — days 1–6 daily, dose 3
MedDRA: Oral mucosal blistering — Feeling: Fair · Site: Pain · Rash, not including the immediate area around the injection site

Free text: Blisters on roof of mouth

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Rash, not including the immediate area around the injection site

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-09
Survey response — day 7, dose 3
MedDRA: Rash, Rash erythematous — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Lacy red rash on abdomen

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Survey response — day 14, dose 3
MedDRA: Asthma, Condition aggravated, Pre-existing disease — Feeling: Fair

Free text: Increase in allergy/asthma type symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Survey response — day 21, dose 3
MedDRA: Hypersensitivity, Pre-existing disease — Feeling: Good

Free text: Mild symptoms of allergy:asthma worsening only slightly.

MedDRA releases: 2024-11 · check-in free text available
2021-11-30
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-07
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-14
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-01
Survey response — 3 months, dose 3
MedDRA: Sinus headache — Feeling: Good

Free text: Sinus head aches

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Survey response — 6 months, dose 3
MedDRA: Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Asthma symptoms (due to seasonal allergies?)

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Dose 4 — Moderna
2022-05-16
Health check-in — day 0, dose 4
Feeling: Fair · None

Adult check-in
2022-05-17
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-05-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-05-20
Survey response — days 1–6 daily, dose 4
MedDRA: Body temperature increased — Feeling: Fair · Site: Pain · Chills, Headache · Be unable to do your normal daily activities

Free text: Low grade fever last night as high as 99.6

MedDRA releases: 2024-11 · check-in free text available
2022-05-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-23
Health check-in — day 7, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-05-30
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-06-08
Survey response — day 21, dose 4
MedDRA: Asthma — Feeling: Fair

Free text: Worsened asthma symptoms.

MedDRA releases: 2024-11 · check-in free text available
2022-06-13
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-20
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-27
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-16
Survey response — 3 months, dose 4
MedDRA: Endoscopy abnormal, Gastrooesophageal reflux disease, Oesophageal disorder, Oesophageal irritation, Oesophageal mucosa erythema, Oesophagitis, Pharyngeal swelling, Pre-existing disease, Throat irritation — Feeling: Fair · Be unable to do your normal daily activities

Free text: I have had slowly increasing symptoms of GERD for the last year to a year and a half. A recent upper endoscopy showed erythema and furrowing in lower 2/3 of esophagus. Biopsy results still pending. Irritation/swelling present in throat/esophagus now

MedDRA releases: 2024-11 · check-in free text available
2022-09-26
Dose 5 — Pfizer-BioNTech
Co-administered: Flu
2022-09-27
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-09-28
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-09-30
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-01
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-10-02
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-03
Health check-in — day 7, dose 5
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-10
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-18
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-10-24
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-31
Survey response — day 35, dose 5
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-11-09
Survey response — day 42, dose 5
MedDRA: Sinus headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sinus headache

MedDRA releases: 2024-11 · check-in free text available
2022-12-26
Survey response — 3 months, dose 5
MedDRA: COVID-19 — Feeling: Good · Be unable to do your normal daily activities

Free text: Covid 19 infection

MedDRA releases: 2024-11 · check-in free text available
2023-03-28
Survey response — 6 months, dose 5
MedDRA: Adverse reaction, COVID-19, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-11	Moderna
2	2021-04-08	Moderna
3	2021-11-02	Moderna	No
4	2022-05-16	Moderna	No
5	2022-09-26	Pfizer-BioNTech	Flu

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — day 7, dose 1

2021-03-18

Systemic reaction (other): Probably unrelated hand pain.

Release 8 — day 28, dose 2

2021-05-06

Symptoms: Rash on left side of my back. Red bumps that itched. This may have been from Shingrix booster immunization on 4/26/2021 (>2 weeks after 2nd Covid immunization-4/8/2021).

Release 10 — 6 months, dose 2

2021-10-07

Symptoms: Some intermittent low grade fevers/headaches and some dark (brown) urine. Both seemed to have resolved mostly.

Release 10 — days 1–6 daily, dose 3

2021-11-05

Systemic reaction (other): Blisters on roof of mouth

Release 10 — day 7, dose 3

2021-11-09

Systemic reaction (other): Lacy red rash on abdomen

Release 10 — day 14, dose 3

2021-11-16

Symptoms: Increase in allergy/asthma type symptoms

Release 10 — day 21, dose 3

2021-11-23

Symptoms: Mild symptoms of allergy:asthma worsening only slightly.

Release 11 — 3 months, dose 3

2022-02-01

Symptoms: Sinus head aches

Release 11 — 6 months, dose 3

2022-05-03

Symptoms: Asthma symptoms (due to seasonal allergies?)

Release 11 — days 1–6 daily, dose 4

2022-05-20

Systemic reaction (other): Low grade fever last night as high as 99.6

Release 11 — day 21, dose 4

2022-06-08

Symptoms: Worsened asthma symptoms.

Release 12 — 3 months, dose 4

2022-08-16

Symptoms: I have had slowly increasing symptoms of GERD for the last year to a year and a half. A recent upper endoscopy showed erythema and furrowing in lower 2/3 of esophagus. Biopsy results still pending. Irritation/swelling present in throat/esophagus now cut off by CDC

Release 12 — day 35, dose 5

2022-10-31

Symptoms: Fatigue

Release 12 — day 42, dose 5

2022-11-09

Symptoms: Sinus headache

Release 12 — 3 months, dose 5

2022-12-26

Symptoms: Covid 19 infection

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	Adverse reaction	·	·	✓
SD	Asthma	·	·	✓
SD	Chromaturia	·	·	✓
SD	Condition aggravated	·	·	✓
SD	COVID-19	·	·	✓
SD	Endoscopy abnormal	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Headache	·	·	✓
SD	Hypersensitivity	·	·	✓
SD	Oesophageal disorder	·	·	✓
SD	Oesophageal irritation	·	·	✓
SD	Oesophageal mucosa erythema	·	·	✓
SD	Oesophagitis	·	·	✓
SD	Pharyngeal swelling	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinus headache	·	·	✓
SD	Throat irritation	·	·	✓
SRO	Body temperature increased	·	·	✓
SRO	Oral mucosal blistering	·	·	✓
SRO	Rash	·	·	✓
SRO	Rash erythematous	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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