5SV-30341-02644
4 vaccinations
9 coded responses
52 check-ins
9 free-text entries
5 call cases
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 210 / MD
- Registered
- 2021-01-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-04
Registered in v-safe
-
2021-01-04
Dose 1 — Moderna
- 2021-01-04
-
2021-01-06
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-01-07
- 2021-01-08
- 2021-01-09
- 2021-01-10
- 2021-01-18
- 2021-01-25
- 2021-02-01
-
2021-02-03
Dose 2 — Moderna
- 2021-02-03
-
2021-02-04
Survey response — days 1–6 daily, dose 2MedDRA: Insomnia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: InsomniaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-05
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-02-06
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-17
-
2021-02-24
Survey response — day 21, dose 2MedDRA: Limb discomfort — Feeling: FairFree text: Pressure (headache?) in forehead. Not painful or constant, comes and goes, and worse at night when laying in bed (stomach sleeper)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-03
Survey response — day 28, dose 2MedDRA: Discomfort, Dizziness, Fatigue, Head discomfort, Headache, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: From 2/22 through 3/2 I had on and off persistent head pressure, occasional lightheadedness, fatigue, and by the last day, minor head ache/discomfort along with the pressure. I was tested for COVID on 2/26 to be safe, but was negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-03
Report sent to call center — day 28, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-10
- 2021-03-17
- 2021-05-05
-
2021-08-06
Survey response — 6 months, dose 2MedDRA: Blood pressure decreased, Loss of consciousness — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Low blood pressure, instance of passing outMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-06
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-12
-
2021-08-12
Call successfulParticipant prefers to complete VAERS report online
-
2021-11-19
Dose 3 — Moderna
- 2021-11-19
-
2021-11-20
Survey response — days 1–6 daily, dose 3MedDRA: Insomnia — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Insomnia last nightMedDRA releases: 2024-11 · check-in free text available
-
2021-11-21
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
-
2021-11-22
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Redness, Swelling · NoneAdult check-in
- 2021-11-23
-
2021-11-24
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Redness, Itching · NoneAdult check-in
- 2021-11-25
-
2021-11-26
Health check-in — day 7, dose 3Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-12-05
Survey response — day 14, dose 3MedDRA: Fatigue, Feeling abnormal, Feeling hot, Headache, Malaise — Feeling: FairFree text: Very tired, especially by the afternoon. Overall on and off feeling of being "off". At times I've almost felt like I have a fever, but I don't. On and off headache. Just an overall run down feeling that's abnormal for my circumstances.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-17
- 2021-12-26
- 2021-12-31
-
2022-02-18
Survey response — 3 months, dose 3MedDRA: Hypoacusis, Meniere's disease — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Developed Ménière's disease, intermittent low frequency hearing lossMedDRA releases: 2024-11 · check-in free text available
-
2022-02-18
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-02-24
-
2022-02-24
Call successfulReported to VAERS voluntarily prior to GDIT contact
-
2022-05-22
Survey response — 6 months, dose 3MedDRA: Deafness — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Ongoing intermittent low frequency hearing lossMedDRA releases: 2024-11 · check-in free text available
-
2022-05-22
Report sent to call center — 6 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-05-23
- 2022-05-23
- 2022-05-23
- 2022-05-23
-
2022-09-14
Dose 4 — Moderna
- 2022-09-14
-
2022-09-16
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, DiarrheaAdult check-in
-
2022-09-17
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2022-09-18
- 2022-09-19
- 2022-09-20
- 2022-09-21
-
2022-09-28
Survey response — day 14, dose 4MedDRA: Discomfort, Flank pain, Loss of consciousness, Pain, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Discomfort to pain in left side, radiating to upper inner right thigh, then briefly passed out.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-28
Report sent to call center — day 14, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-09-29
Call successfulDoes not wish to fill out VAERS report
-
2022-09-29
Call successfulCompleted over the phone
- 2022-10-05
- 2022-10-12
- 2022-10-19
- 2022-10-26
- 2022-12-14
- 2023-03-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-04 | Moderna | |
| 2 | 2021-02-03 | Moderna | |
| 3 | 2021-11-19 | Moderna | No |
| 4 | 2022-09-14 | Moderna | No |
Call center
5 call center cases
5 successful
VAERS report filed, before or during a call: 2
1 wait over 3 months for a first call
Free text
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): Insomnia
Release 4 — day 21, dose 2
Symptoms: Pressure (headache?) in forehead. Not painful or constant, comes and goes, and worse at night when laying in bed (stomach sleeper)
Release 4 — day 28, dose 2
Symptoms: From 2/22 through 3/2 I had on and off persistent head pressure, occasional lightheadedness, fatigue, and by the last day, minor head ache/discomfort along with the pressure. I was tested for COVID on 2/26 to be safe, but was negative.
Release 9 — 6 months, dose 2
Symptoms: Low blood pressure, instance of passing out
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Insomnia last night
Release 10 — day 14, dose 3
Symptoms: Very tired, especially by the afternoon. Overall on and off feeling of being "off". At times I've almost felt like I have a fever, but I don't. On and off headache. Just an overall run down feeling that's abnormal for my circumstances.
Release 11 — 3 months, dose 3
Symptoms: Developed Ménière's disease, intermittent low frequency hearing loss
Release 11 — 6 months, dose 3
Symptoms: Ongoing intermittent low frequency hearing loss
Release 12 — day 14, dose 4
Symptoms: Discomfort to pain in left side, radiating to upper inner right thigh, then briefly passed out.
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 | Blood pressure decreased | ✓ | · | ✓ |
| SD | Deafness | · | · | ✓ |
| SD | Discomfort | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Feeling abnormal | · | · | ✓ |
| SD | Feeling hot | · | · | ✓ |
| SD | Flank pain | · | · | ✓ |
| SD | Head discomfort | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Hypoacusis | · | · | ✓ |
| SD | Limb discomfort | ✓ | ✓ | ✓ |
| SD | Loss of consciousness | ✓ | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Meniere's disease | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release