5UD-29813-16766

5 vaccinations 14 coded responses 25 check-ins 14 free-text entries 5 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 021 / MA
Registered: 2021-03-29

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

2021-02-26
Dose 1 — Moderna
2021-03-26
Dose 2 — Moderna
2021-03-29
Registered in v-safe
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease, Rhinorrhoea — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Asthma, runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Nasal congestion, Thinking abnormal, Tremor, Ulcer — Feeling: Fair · Site: Itching · Chills, Headache, Fatigue or tiredness · Be unable to work

Free text: Stuffy nose, sores inside nose , shaky and not thinking clearly

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinalgia — Feeling: Good

Free text: Sores in nose still healing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — day 7, dose 2
MedDRA: Respiratory tract congestion, Rhinorrhoea — Feeling: Good · Fatigue or tiredness, Nausea

Free text: Congestion and Runny nose -could be seasonalAllergies

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

Adult check-in
2021-04-16
Survey response — day 21, dose 2
MedDRA: Axillary pain, Cheilitis, Dizziness, Pre-existing disease, Rash, Rash pruritic, Seasonal allergy, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Pain in my armpit and itchy bumps on lips and above lips that come and go . Never had that before with my seasonal allergies and its definitely not cold sores. (Dizziness likely due to pre-existing heart arrhythmias not related to vaccine) · Healthcare visit (other): Made appointment with a new cardiologist for tests and consult in 2 weeks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-09
Survey response — day 42, dose 2
MedDRA: Anxiety, Condition aggravated, Dental operation, Depression, Pre-existing disease, Wisdom teeth removal — Feeling: Good · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Not covid related. My heart arrhythmias are worse. I have an appointment with my cardiologist. Anxiety and depression continues to make life difficult. Had a wisdom tooth extracted also. Very glad I was vaccinated! · Healthcare visit (other): Also Dental surgery

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Report sent to call center — day 42, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-26
Survey response — 3 months, dose 2
MedDRA: Arrhythmia, Fluid retention, Office visit, Postmenopausal haemorrhage, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Severe post menopausal bleeding. , plus heart arrhythmias worsening with swelling/water retention in ankles and calves. I have cardiac sarcoidosis with an ICD/pacemaker · Healthcare visit (other): Have in person appointments scheduled with Gyn and Cardiology

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-26
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-30
Call 1 — Left Voicemail
2021-06-30
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-24
Survey response — 6 months, dose 2
MedDRA: Asthma, Cardiac sarcoidosis, Dyspnoea, Palpitations, Pre-existing disease, Tachycardia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Asthma and shortness of breath most likely allergy related as its ragweed season. Also heart palpitations and tachycardia upon exercise even just walking, I have a cardiology appointment in a few weeks. I have an ICD due to cardiac sarcoidosis.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Dose 3 — Moderna
2022-03-26
Survey response — 12 months, dose 2
MedDRA: Angioplasty, Arrhythmia, Condition aggravated, Coronary arterial stent insertion, Coronary artery occlusion, Dyspnoea, Palpitations, Pre-existing disease, Stent placement — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: Major blockage of the LAD artery in my heart had to have 2 stents placed. Also had a flare up of my cardiac sarcoidosis with ongoing arrhythmia and will be having PET soon. Have episodes of shortness of breath and heart palpitations · Healthcare visit (other): Angioplasty and 2 stents placed.

MedDRA releases: 2024-11 · check-in free text available
2022-03-26
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

Outpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
2022-03-28
Call 1 — Left Voicemail
2022-03-28
Call successful
Participant prefers to complete VAERS report online
2022-04-16
Dose 4 — Moderna
Co-administered: Flu
2022-09-16
Dose 5 — Moderna
2022-09-17
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Swelling · Fatigue or tiredness

Adult check-in
2022-09-19
Survey response — days 1–6 daily, dose 5
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Mild asthma and allergy symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-09-20
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-09-21
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-22
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-09-23
Health check-in — day 7, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-30
Survey response — day 14, dose 5
MedDRA: Asthma, Hypersensitivity, Nasal pruritus, Ocular hyperaemia, Pre-existing disease, SARS-CoV-2 test negative, Sneezing — Feeling: Good

Free text: Extreme allergies , sneezing , runny itchy nose , red eyes. Mild asthma. I took a rapid covid test and it was negative so this is probably ragweed allergies although I haven't been outside. No fever.

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-14
Survey response — day 28, dose 5
MedDRA: Asthma, Cough, Eye pruritus, Fatigue, Headache, Oropharyngeal pain, Pruritus, Sneezing, Upper-airway cough syndrome — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Asthma, coughing, headache, fatigue , sore throat , sneezing, post nasal drip, itching eyes and generalized itching for no apparent reason ( no hives)

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-10-30
Survey response — day 42, dose 5
MedDRA: Adverse drug reaction, Bladder disorder, Nausea, Sinusitis — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Nausea, sinusitis, bladder problem · Healthcare visit (other): Will have appointment with primary care in 2 weeks, talking to psychiatrist this week as new antidepressant caused the nausea

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Report sent to call center — day 42, dose 5
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-31
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	2021-02-26	Moderna
2	2021-03-26	Moderna
3	2021-11-19	Moderna	No
4	2022-04-16	Moderna	Flu
5	2022-09-16	Moderna	No

Call center

5 call center cases

5 successful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-29

Systemic reaction (other): Asthma, runny nose

2021-03-30

Systemic reaction (other): Stuffy nose, sores inside nose , shaky and not thinking clearly

2021-03-31

Systemic reaction (other): Sores in nose still healing

2021-04-01

Systemic reaction (other): None

Release 6 — day 7, dose 2

2021-04-02

Systemic reaction (other): Congestion and Runny nose -could be seasonalAllergies

Release 7 — day 21, dose 2

2021-04-16

Symptoms: Pain in my armpit and itchy bumps on lips and above lips that come and go . Never had that before with my seasonal allergies and its definitely not cold sores. (Dizziness likely due to pre-existing heart arrhythmias not related to vaccine)

Healthcare visit (other): Made appointment with a new cardiologist for tests and consult in 2 weeks

Release 8 — day 42, dose 2

2021-05-09

Symptoms: Not covid related. My heart arrhythmias are worse. I have an appointment with my cardiologist. Anxiety and depression continues to make life difficult. Had a wisdom tooth extracted also. Very glad I was vaccinated!

Healthcare visit (other): Also Dental surgery

Release 9 — 3 months, dose 2

2021-06-26

Symptoms: Severe post menopausal bleeding. , plus heart arrhythmias worsening with swelling/water retention in ankles and calves. I have cardiac sarcoidosis with an ICD/pacemaker

Healthcare visit (other): Have in person appointments scheduled with Gyn and Cardiology

Release 9 — 6 months, dose 2

2021-09-24

Symptoms: Asthma and shortness of breath most likely allergy related as its ragweed season. Also heart palpitations and tachycardia upon exercise even just walking, I have a cardiology appointment in a few weeks. I have an ICD due to cardiac sarcoidosis.

Release 11 — 12 months, dose 2

2022-03-26

Symptoms: Major blockage of the LAD artery in my heart had to have 2 stents placed. Also had a flare up of my cardiac sarcoidosis with ongoing arrhythmia and will be having PET soon. Have episodes of shortness of breath and heart palpitations

Healthcare visit (other): Angioplasty and 2 stents placed.

Release 12 — days 1–6 daily, dose 5

2022-09-19

Systemic reaction (other): Mild asthma and allergy symptoms

Release 12 — day 14, dose 5

2022-09-30

Symptoms: Extreme allergies , sneezing , runny itchy nose , red eyes. Mild asthma. I took a rapid covid test and it was negative so this is probably ragweed allergies although I haven't been outside. No fever.

Release 12 — day 28, dose 5

2022-10-14

Symptoms: Asthma, coughing, headache, fatigue , sore throat , sneezing, post nasal drip, itching eyes and generalized itching for no apparent reason ( no hives)

Release 12 — day 42, dose 5

2022-10-30

Symptoms: Nausea, sinusitis, bladder problem

Healthcare visit (other): Will have appointment with primary care in 2 weeks, talking to psychiatrist this week as new antidepressant caused the nausea

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	Adverse drug reaction	·	·	✓
HCVO	Angioplasty	·	·	✓
HCVO	Dental operation	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Stent placement	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Anxiety	✓	✓	✓
SD	Arrhythmia	✓	✓	✓
SD	Asthma	·	·	✓
SD	Axillary pain	✓	✓	✓
SD	Bladder disorder	·	·	✓
SD	Cardiac sarcoidosis	·	·	✓
SD	Cheilitis	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Coronary arterial stent insertion	·	·	✓
SD	Coronary artery occlusion	·	·	✓
SD	Cough	·	·	✓
SD	Depression	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	·	·	✓
SD	Eye pruritus	·	·	✓
SD	Fatigue	·	·	✓
SD	Fluid retention	✓	✓	✓
SD	Headache	·	·	✓
SD	Hypersensitivity	·	·	✓
SD	Nasal pruritus	·	·	✓
SD	Nausea	·	·	✓
SD	Ocular hyperaemia	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Palpitations	·	·	✓
SD	Postmenopausal haemorrhage	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Seasonal allergy	✓	✓	✓
SD	Sinusitis	·	·	✓
SD	Sneezing	·	·	✓
SD	Tachycardia	·	·	✓
SD	Upper-airway cough syndrome	·	·	✓
SD	Wisdom teeth removal	✓	✓	✓
SRO	Asthma	○	✓	✓
SRO	Nasal congestion	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	✓	·	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinalgia	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Thinking abnormal	✓	✓	✓
SRO	Tremor	✓	✓	✓
SRO	Ulcer	✓	✓	✓

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