63X-26585-77009

3 vaccinations 11 coded responses 40 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 080 / NJ
Registered: 2021-09-29

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-09-29
Registered in v-safe
2021-10-01
Dose 1 — Moderna
2021-10-01
Survey response — day 0, dose 1
MedDRA: Cough — Feeling: Fair · Site: Pain · Chills, Joint pains, Muscle or body aches

Free text: Slight dry cough

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Medical counselling, Nasal congestion, Oropharyngeal pain — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · 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: Systemic reaction (other): Coughing, sore throat, stuffy nose · Healthcare visit (other): Phone call

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — days 1–6 daily, dose 1
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)
2021-10-03
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Nasal congestion, Oropharyngeal pain — Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Coughing, stuffy nose, sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-10-04
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Lymphadenopathy, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness, Nausea

Free text: Cough, swollen glands, sore throat, blowing nose

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Lymphadenopathy, Nasal congestion, Oropharyngeal pain — Feeling: Fair · Fatigue or tiredness

Free text: Cough, swollen glands, stuffy nose, sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Lymphadenopathy, Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Headache, Fatigue or tiredness · 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: Swollen glands, cough, congestion, sore throats

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — days 1–6 daily, dose 1
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)
2021-10-07
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Lymphadenopathy, Nasal congestion — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Cough, stuffy nose, swollen glands

MedDRA releases: 2024-11 · check-in free text available
2021-10-08
Survey response — day 7, dose 1
MedDRA: Cough, Lymphadenopathy, Nasal congestion, Oropharyngeal pain — Feeling: Fair

Free text: Stuffy nose, coughing, sore throat, swollen glands

MedDRA releases: 2024-11 · check-in free text available
2021-10-08
Call successful
Participant prefers to complete VAERS report online
2021-10-16
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-10-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-10-29
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-11-06
Dose 2 — Moderna
2021-11-06
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Itching · Chills, Headache · Be unable to do your normal daily activities

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Headache, Muscle or body aches, Nausea, Diarrhea

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-11-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-12-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-12-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-02-05
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-05-07
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-06-22
Dose 3 — Moderna
2022-06-22
Survey response — day 0, dose 3
MedDRA: Cough, Dyspnoea — Feeling: Fair · Site: Pain · Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Slight cough, tightness breathing

MedDRA releases: 2024-11 · check-in free text available
2022-06-23
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Dyspnoea — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cough - weird shortness of breath sort of

MedDRA releases: 2024-11 · check-in free text available
2022-06-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-06-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-06-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2022-06-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-06-30
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-07-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-07-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-07-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-07-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-08-03
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-09-21
Survey response — 3 months, dose 3
MedDRA: Anaemia — 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 visit

Free text: Anemia

MedDRA releases: 2024-11 · check-in free text available
2022-09-21
Report sent to call center — 3 months, dose 3
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)
2022-09-22
Call successful
Does not wish to fill out VAERS report
2022-12-21
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-06-22
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-10-01	Moderna	No
2	2021-11-06	Moderna	No
3	2022-06-22	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 9 — day 0, dose 1

2021-10-01

Systemic reaction (other): Slight dry cough

Release 9 — days 1–6 daily, dose 1

2021-10-02

Systemic reaction (other): Coughing, sore throat, stuffy nose

Healthcare visit (other): Phone call

2021-10-03

Systemic reaction (other): Coughing, stuffy nose, sore throat

Release 10 — days 1–6 daily, dose 1

2021-10-04

Systemic reaction (other): Cough, swollen glands, sore throat, blowing nose

2021-10-05

Systemic reaction (other): Cough, swollen glands, stuffy nose, sore throat

2021-10-06

Systemic reaction (other): Swollen glands, cough, congestion, sore throats

2021-10-07

Systemic reaction (other): Cough, stuffy nose, swollen glands

Release 10 — day 7, dose 1

2021-10-08

Systemic reaction (other): Stuffy nose, coughing, sore throat, swollen glands

Release 12 — day 0, dose 3

2022-06-22

Systemic reaction (other): Slight cough, tightness breathing

Release 12 — days 1–6 daily, dose 3

2022-06-23

Systemic reaction (other): Cough - weird shortness of breath sort of

Release 12 — 3 months, dose 3

2022-09-21

Symptoms: Anemia

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	Medical counselling	·	·	✓
SD	Anaemia	·	·	✓
SRO	Cough	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Nasal congestion	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Respiratory tract congestion	·	·	✓
SRO	Rhinorrhoea	·	·	✓

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