6A3-21817-15457

3 vaccinations 29 coded responses 38 check-ins 29 free-text entries 7 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 958 / CA
Registered: 2021-01-14

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Registered dependents

AXU-26319-32018 Child or adolescent in my care · Male · 2021-06-30

KCL-17698-88465 Child or adolescent in my care · Female · 2021-12-19

Timeline

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — day 0, dose 1
MedDRA: Sensation of foreign body, Somnolence — Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Drowsiness, feel as if theres something in my throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — day 0, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Palpitations, Paraesthesia, Peripheral coldness — Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, 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: Lightheaded, cold hands, tingling on the hands, palpitations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal pain upper, Asthenia — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Feeling weak, stomach cramps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Good · Headache

Free text: Dry cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — day 7, dose 1
MedDRA: Ear pain — Feeling: Good · Headache, Joint pains

Free text: Earache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Survey response — day 21, dose 1
MedDRA: Episcleritis, Eye pain, Fatigue, Headache, Myalgia, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: More frequent and severe headaches with pain behind the eye. Left episcleritis, muscle pain on legs, feeling tired.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-11
Survey response — day 28, dose 1
MedDRA: Headache — Feeling: Fair

Free text: Headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Dose 2 — Moderna
2021-02-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Hyperhidrosis, Pruritus, Tonsillar hypertrophy — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Sweating, Itching all over the body; swollen tonsils, dry cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain — Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Ear-ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Feeling weak

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling · Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Headache

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · Headache

Adult check-in
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Survey response — day 21, dose 2
MedDRA: Injection site pruritus — Feeling: Good

Free text: Itchy on injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Call 1 — Left Voicemail
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Survey response — day 35, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 42, dose 2
MedDRA: Headache, Influenza like illness, Nasopharyngitis, Pain — Feeling: Good

Free text: Headaches, body aches and felt as if coming down with a cold or flu.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Headache — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Headaches, joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-15
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Breast pain, Headache — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headaches, joint pain, breasts pain

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-12-15
Dose 3 — Moderna
2021-12-16
Survey response — days 1–6 daily, dose 3
MedDRA: Back pain — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Pain in lower back

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — days 1–6 daily, dose 3
MedDRA: Burning sensation — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Burning sensation in lower back

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Survey response — days 1–6 daily, dose 3
MedDRA: Aphthous ulcer — Feeling: Good · Site: Pain, Itching

Free text: Canker sores

MedDRA releases: 2024-11 · check-in free text available
2021-12-19
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Palpitations — Feeling: Good · Site: Pain

Free text: Dry cough, heart palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-12-20
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Palpitations — Feeling: Fair · Site: Pain, Itching · Headache

Free text: Palpitations and dry cough

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Survey response — days 1–6 daily, dose 3
MedDRA: Palpitations — Feeling: Fair · Site: Pain · Headache · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-22
Health check-in — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2021-12-22
Call successful
Does not wish to fill out VAERS report
2021-12-22
Call successful
Does not wish to fill out VAERS report
2021-12-22
Call successful
Does not wish to fill out VAERS report
2021-12-22
Call successful
Does not wish to fill out VAERS report
2021-12-22
Call successful
Does not wish to fill out VAERS report
2021-12-29
Survey response — day 14, dose 3
MedDRA: Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headaches

MedDRA releases: 2024-11 · check-in free text available
2022-01-05
Survey response — day 21, dose 3
MedDRA: Fatigue, Headache, Injection site pain — Feeling: Good

Free text: Pain on injection site; headaches and feeling tired. The skin close to injection site is sensitive to touch and feels like a burning sensation.

MedDRA releases: 2024-11 · check-in free text available
2022-01-08
Health check-in — day 0, dose 2, dependent
Feeling: Fair · Site: Pain, Swelling · Chills, Fatigue or tiredness

Adult check-in
2022-01-12
Survey response — day 28, dose 3
MedDRA: Back pain, Headache, Injection site pain, Injection site pruritus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Back pain, headaches, pain and itchy injection site.

MedDRA releases: 2024-11 · check-in free text available
2022-01-19
Survey response — day 35, dose 3
MedDRA: Eye irritation, Headache, Oropharyngeal pain, Pain — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Body aches, sore throat, eyes felt like burning, headaches.

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Survey response — day 42, dose 3
MedDRA: Arthralgia, Breast pain, Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Joint pain, breast pain, headaches, feeling tired.

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Survey response — 3 months, dose 3
MedDRA: Burning sensation, Coccydynia, Headache — 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

Free text: Burning sensation under arm where injection site is located. Frequent headaches. Pain on coccyx.

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Report sent to call center — 3 months, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-18
Call 1 — Left Voicemail
2022-06-15
Survey response — 6 months, dose 3
MedDRA: Back pain, Chills, Cough, Fatigue, Headache, Injection site reaction, Sensitive skin — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Back pain, fatigue, cough, chills, sensitive skin around injection site, headaches.

MedDRA releases: 2024-11 · check-in free text available
2022-12-15
Survey response — 12 months, dose 3
MedDRA: Fatigue, Gastrointestinal disorder, Headache, Influenza, Nasal congestion, Pain, Rhinorrhoea — 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

Free text: Fly with body aches, headaches, runny/stuffy nose and tiredness. Stomach problems have increased.

MedDRA releases: 2024-11 · check-in free text available
2022-12-15
Report sent to call center — 12 months, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-12-16
Call 1 — Could Not Reach Participant
2022-12-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-16
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	2021-01-14	Moderna
2	2021-02-12	Moderna
3	2021-12-15	Moderna	No

Call center

7 call center cases

7 successful

See the call center timeline

Free text

Release 2 — day 0, dose 1

2021-01-14

Systemic reaction (other): Drowsiness, feel as if theres something in my throat.

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Lightheaded, cold hands, tingling on the hands, palpitations

2021-01-16

Systemic reaction (other): Feeling weak, stomach cramps

2021-01-19

Systemic reaction (other): Dry cough

Release 2 — day 7, dose 1

2021-01-21

Systemic reaction (other): Earache

Release 3 — day 21, dose 1

2021-02-04

Symptoms: More frequent and severe headaches with pain behind the eye. Left episcleritis, muscle pain on legs, feeling tired.

Release 4 — day 28, dose 1

2021-02-11

Symptoms: Headaches

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Sweating, Itching all over the body; swollen tonsils, dry cough

2021-02-14

Systemic reaction (other): Ear-ache

2021-02-15

Systemic reaction (other): Feeling weak

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Itchy on injection site

Release 6 — day 35, dose 2

2021-03-19

Symptoms: Headaches

Release 6 — day 42, dose 2

2021-03-26

Symptoms: Headaches, body aches and felt as if coming down with a cold or flu.

Release 8 — 3 months, dose 2

2021-05-14

Symptoms: Headaches, joint pain

Release 9 — 6 months, dose 2

2021-08-15

Symptoms: Headaches, joint pain, breasts pain

Release 10 — days 1–6 daily, dose 3

2021-12-16

Systemic reaction (other): Pain in lower back

2021-12-17

Systemic reaction (other): Burning sensation in lower back

2021-12-18

Systemic reaction (other): Canker sores

2021-12-19

Systemic reaction (other): Dry cough, heart palpitations

2021-12-20

Systemic reaction (other): Palpitations and dry cough

2021-12-21

Systemic reaction (other): Palpitations

Release 10 — day 14, dose 3

2021-12-29

Symptoms: Headaches

Release 10 — day 21, dose 3

2022-01-05

Symptoms: Pain on injection site; headaches and feeling tired. The skin close to injection site is sensitive to touch and feels like a burning sensation.

Release 10 — day 28, dose 3

2022-01-12

Symptoms: Back pain, headaches, pain and itchy injection site.

Release 10 — day 35, dose 3

2022-01-19

Symptoms: Body aches, sore throat, eyes felt like burning, headaches.

Release 11 — day 42, dose 3

2022-01-26

Symptoms: Joint pain, breast pain, headaches, feeling tired.

Release 11 — 3 months, dose 3

2022-03-16

Symptoms: Burning sensation under arm where injection site is located. Frequent headaches. Pain on coccyx.

Release 12 — 6 months, dose 3

2022-06-15

Symptoms: Back pain, fatigue, cough, chills, sensitive skin around injection site, headaches.

Release 12 — 12 months, dose 3

2022-12-15

Symptoms: Fly with body aches, headaches, runny/stuffy nose and tiredness. Stomach problems have increased.

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	Arthralgia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Breast pain	✓	·	✓
SD	Burning sensation	·	·	✓
SD	Chills	·	·	✓
SD	Coccydynia	·	·	✓
SD	Cough	·	·	✓
SD	Episcleritis	✓	✓	✓
SD	Eye irritation	·	·	✓
SD	Eye pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	✓	✓	✓
SD	Influenza	·	·	✓
SD	Influenza like illness	✓	✓	✓
SD	Injection site pain	·	·	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site reaction	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Sensitive skin	·	·	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Aphthous ulcer	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Back pain	·	·	✓
SRO	Burning sensation	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Peripheral coldness	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Sensation of foreign body	✓	✓	✓
SRO	Somnolence	✓	✓	✓
SRO	Tonsillar hypertrophy	✓	✓	✓

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