67U-15939-46362

5 vaccinations 10 coded responses 50 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 160 / PA
Registered: 2021-01-25

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

2021-01-25
Registered in v-safe
2021-01-25
Dose 1 — Moderna
2021-01-25
Health check-in — day 0, dose 1
Feeling: Good · Site: Itching · Muscle or body aches

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Epistaxis — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Bleeding left nostril in AM while in shower. Light, stopped within 1 hour. Nothing more for the rest of the day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-01
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-22
Dose 2 — Moderna
2021-02-23
Survey response — days 1–6 daily, dose 2
MedDRA: Epistaxis, Paranasal sinus hypersecretion — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches

Free text: Extra nasal discharge and bloody nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Rash — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Rash on right front near collarbone this morning it did itch but soon stopped itching and is no longer there

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Survey response — day 14, dose 2
MedDRA: Rhinorrhoea — Feeling: Fair

Free text: Runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-29
Survey response — day 35, dose 2
MedDRA: Rhinorrhoea — Feeling: Fair

Free text: Runny nose

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

Free text: Stomach a bit nauseous. May not be related to the vaccine however

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-28
Dose 3 — Moderna
2021-10-28
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Runny nose

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-11
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-09
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-08
Dose 4 — Moderna
2022-04-20
Health check-in — day 7, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-04-23
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-04-30
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-09
Dose 5 — Moderna
2022-09-25
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-09-30
Survey response — day 21, dose 5
MedDRA: Rhinorrhoea — Feeling: Fair

Free text: Slight runny nose while wearing mask

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-10-14
Survey response — day 35, dose 5
MedDRA: Respiratory tract infection viral — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Respiratory infection (not COVID), viral

MedDRA releases: 2024-11 · check-in free text available
2022-10-14
Report sent to call center — day 35, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-17
Call 1 — Left Voicemail
2022-10-20
Call 2 — Left Voicemail
2022-10-20
Callback requested for
10:00AM ET
2022-10-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-21
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-09
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-03-10
Survey response — 6 months, dose 5
MedDRA: Back pain, COVID-19, Nasopharyngitis — 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 · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-03-10
Report sent to call center — 6 months, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-03-14
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-22	Moderna
3	2021-10-28	Moderna	No
4	2022-04-08	Moderna	No
5	2022-09-09	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Bleeding left nostril in AM while in shower. Light, stopped within 1 hour. Nothing more for the rest of the day.

Release 4 — days 1–6 daily, dose 2

2021-02-23

Systemic reaction (other): Extra nasal discharge and bloody nose

2021-02-25

Systemic reaction (other): Rash on right front near collarbone this morning it did itch but soon stopped itching and is no longer there

Release 5 — day 14, dose 2

2021-03-08

Symptoms: Runny nose

Release 6 — day 35, dose 2

2021-03-29

Symptoms: Runny nose

Release 6 — day 42, dose 2

2021-04-05

Symptoms: Stomach a bit nauseous. May not be related to the vaccine however

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Runny nose

Release 12 — day 21, dose 5

2022-09-30

Symptoms: Slight runny nose while wearing mask

Release 12 — day 35, dose 5

2022-10-14

Symptoms: Respiratory infection (not COVID), viral

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	Back pain	·	·	✓
SD	COVID-19	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	✓	✓	✓
SD	Respiratory tract infection viral	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Epistaxis	✓	✓	✓
SRO	Paranasal sinus hypersecretion	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rhinorrhoea	·	·	✓

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