64B-13685-99030

3 vaccinations 13 coded responses 23 check-ins 13 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 372 / TN
Registered: 2021-03-09

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-08
Dose 1 — Moderna
2021-03-09
Registered in v-safe
2021-03-09
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: One question that isnt being ask is, if I have had Covid and if so how long ago.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: Lymphadenopathy, Nodule — Feeling: Good · Fatigue or tiredness

Free text: Lymph Nodes swollen near clavicle bone. Knot on clavicle. Started 12 hours after injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Diarrhea

Adult check-in
2021-03-15
Survey response — day 7, dose 1
MedDRA: Menstrual disorder — Feeling: Good

Free text: My blood from my cycle was darker than normal. The shedding of my uterus lining lasted longer than usual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-04-05
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tiredness

Free text: Since my first shot I have noticed my mother skills being off. I bump into things and find my self dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Clumsiness, Disorientation — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Disoriented, clumsy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Fever · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains

Adult check-in
2021-04-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-26
Survey response — day 21, dose 2
MedDRA: Dizziness — Feeling: Fair

Free text: Dizziness. In the beginning it was just a little bit now I notice it throughout the day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-12
Survey response — day 35, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to work

Free text: Fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Hypoaesthesia — Feeling: Good

Free text: Hands going numb easily

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2022-04-17
Dose 3 — Moderna
2022-04-30
Survey response — day 7, dose 3
MedDRA: Cough — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: My cough has worsened

MedDRA releases: 2024-11 · check-in free text available
2022-05-01
Survey response — day 14, dose 3
MedDRA: Cough — Feeling: Fair

Free text: Dry cough has increased

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Survey response — day 21, dose 3
MedDRA: Angina pectoris — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Had to have an EKG. Ache around heart

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-11
Call 1 — Left Voicemail
2022-05-15
Survey response — day 28, dose 3
MedDRA: Cough, Fatigue — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Cough fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-16
Call successful
Participant prefers to complete VAERS report online
2022-05-16
Call successful
Participant prefers to complete VAERS report online
2022-10-16
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-05	Moderna
3	2022-04-17	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-09

Systemic reaction (other): Cough

2021-03-10

Systemic reaction (other): One question that isnt being ask is, if I have had Covid and if so how long ago.

2021-03-11

Systemic reaction (other): Lymph Nodes swollen near clavicle bone. Knot on clavicle. Started 12 hours after injection

Release 5 — day 7, dose 1

2021-03-15

Systemic reaction (other): My blood from my cycle was darker than normal. The shedding of my uterus lining lasted longer than usual

Release 6 — day 0, dose 2

2021-04-05

Systemic reaction (other): Since my first shot I have noticed my mother skills being off. I bump into things and find my self dizzy

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Disoriented, clumsy

Release 8 — day 21, dose 2

2021-04-26

Symptoms: Dizziness. In the beginning it was just a little bit now I notice it throughout the day.

Release 8 — day 35, dose 2

2021-05-12

Symptoms: Fatigue

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Hands going numb easily

Release 11 — day 7, dose 3

2022-04-30

Systemic reaction (other): My cough has worsened

Release 11 — day 14, dose 3

2022-05-01

Symptoms: Dry cough has increased

Release 11 — day 21, dose 3

2022-05-10

Symptoms: Had to have an EKG. Ache around heart

Release 11 — day 28, dose 3

2022-05-15

Symptoms: Cough fatigue

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	Angina pectoris	·	·	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SRO	Clumsiness	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Menstrual disorder	✓	✓	✓
SRO	Nodule	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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