5ZJ-13089-03991

4 vaccinations 7 coded responses 40 check-ins 7 free-text entries 7 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 105 / NY
Registered: 2021-04-04

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
2062306 (opens in a new window)	high	10 / 11	—	4 of 16 VAERS symptoms	same dose (3)	NY matches	2021-12-08 / 2022-01-02 / 2022-01-25 received the same day as the last call	case 80615

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-05
Dose 1 — Moderna
2021-04-02
Dose 2 — Moderna
2021-04-04
Registered in v-safe
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-01
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-12-08
Dose 3 — Moderna
2021-12-09
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 · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-12
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-13
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-12-14
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2021-12-17
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-22
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-05
Survey response — day 28, dose 3
MedDRA: Colitis, Hospitalisation — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Rx colitis 1/5/22. Admitted to hospital.

MedDRA releases: 2024-11 · check-in free text available
2022-01-05
Report sent to call center — day 28, 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)
2022-01-06
Call 1 — Left Voicemail
2022-01-07
Call 2 — Left Voicemail
2022-01-12
Survey response — day 35, dose 3
MedDRA: Asthma, Atrial fibrillation, Colitis, Food allergy, Hospitalisation, Pre-existing disease, SARS-CoV-2 test negative — 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: Colitis, Atrial fibrillation, asthma exacerbation. Hospitalized 1/5/22-1/12/22. Reaction to bad oyster. Covid tests (3) negative

MedDRA releases: 2024-11 · check-in free text available
2022-01-12
Report sent to call center — day 35, 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)
2022-01-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-01-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-01-19
Survey response — day 42, dose 3
MedDRA: Asthma, Atrial fibrillation, Colitis, Hospitalisation, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Discharge from hospital 1/12/22. Dx colitis, atrial fibrillation, asthma exacerbation No covid or vaccine related illnesses

MedDRA releases: 2024-11 · check-in free text available
2022-01-19
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-01-20
Call 1 — Could Not Reach Participant
2022-01-25
Call successful
Completed over the phone
2022-03-09
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-10
Survey response — 6 months, dose 3
MedDRA: Herpes zoster — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Shingles

MedDRA releases: 2024-11 · check-in free text available
2022-06-10
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-06-13
Call 1 — Left Voicemail
2022-07-29
Dose 4 — Moderna
2022-07-30
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-07-31
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-08-01
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-08-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-08-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-08-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-08-05
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-08-12
Survey response — day 14, dose 4
MedDRA: Office visit, Peripheral swelling — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Bilateral leg swelling. Had started on new bp medication (valsartan). Saw cardiologist, d/c medication. Diuretics started · Healthcare visit (other): Saw cardiologist

MedDRA releases: 2024-11 · check-in free text available
2022-08-12
Report sent to call center — day 14, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-15
Call successful
Not applicable - Accidental Reporting
2022-08-15
Call successful
Not applicable - Accidental Reporting
2022-08-19
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-26
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-09-02
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-09-09
Survey response — day 42, dose 4
MedDRA: Asthma, Hospitalisation, Oedema peripheral, Office visit, Pre-existing disease, SARS-CoV-2 test negative — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Asthma exacerbation, lower leg/foot edema Admitted to hospital 9/8/22. Cardiologist- no heart failure, Pulmonologist- working to identify reason for problems. Covid Pcr negative.

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Report sent to call center — day 42, 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 · Hospitalization · 1 call case(s)
2022-09-12
Call 1 — Requested Callback
2022-09-20
Call 2 — Left Voicemail
2022-09-20
Callback requested for
11:00AM ET
2022-10-28
Survey response — 3 months, dose 4
MedDRA: Hospitalisation, Myocardial infarction, Pyrexia, Rehabilitation therapy, Viral infection — Feeling: Fair · 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: 10/2 - fever to 103.6, demand myocardial infarction. Fever determined to be viral. Hospitalization for 10 days. Acute rehab for 17 days

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-31
Call 3 — Left Voicemail
2022-10-31
Call 1 — Left Voicemail
2022-10-31
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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	2021-03-05	Moderna
2	2021-04-02	Moderna
3	2021-12-08	Moderna	No
4	2022-07-29	Moderna	No

Call center

7 call center cases

7 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 10 — day 28, dose 3

2022-01-05

Symptoms: Rx colitis 1/5/22. Admitted to hospital.

Release 10 — day 35, dose 3

2022-01-12

Symptoms: Colitis, Atrial fibrillation, asthma exacerbation. Hospitalized 1/5/22-1/12/22. Reaction to bad oyster. Covid tests (3) negative

Release 10 — day 42, dose 3

2022-01-19

Symptoms: Discharge from hospital 1/12/22. Dx colitis, atrial fibrillation, asthma exacerbation No covid or vaccine related illnesses

Release 12 — 6 months, dose 3

2022-06-10

Symptoms: Shingles

Release 12 — day 14, dose 4

2022-08-12

Symptoms: Bilateral leg swelling. Had started on new bp medication (valsartan). Saw cardiologist, d/c medication. Diuretics started

Healthcare visit (other): Saw cardiologist

Release 12 — day 42, dose 4

2022-09-09

Symptoms: Asthma exacerbation, lower leg/foot edema Admitted to hospital 9/8/22. Cardiologist- no heart failure, Pulmonologist- working to identify reason for problems. Covid Pcr negative.

Release 12 — 3 months, dose 4

2022-10-28

Symptoms: 10/2 - fever to 103.6, demand myocardial infarction. Fever determined to be viral. Hospitalization for 10 days. Acute rehab for 17 days

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	Office visit	·	·	✓
SD	Asthma	·	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Colitis	·	·	✓
SD	Food allergy	·	·	✓
SD	Herpes zoster	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Myocardial infarction	·	·	✓
SD	Oedema peripheral	·	·	✓
SD	Office visit	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rehabilitation therapy	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Viral infection	·	·	✓

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