6FG-10090-03053

3 vaccinations 8 coded responses 33 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 26-30
ZIP prefix: 930 / CA
Registered: 2021-01-12

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-12
Registered in v-safe
2021-01-12
Dose 1 — Moderna
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness, Nausea

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness, Nausea

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Nausea

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-01-19
Survey response — day 7, dose 1
MedDRA: Chest pain, Injection site pruritus, Injection site rash — Feeling: Fair · Site: Pain, Redness, Swelling, Itching

Free text: I felt pain on the right side of my chest - it lasted for about 2 hours. The rash on the vaccine site came back and its really itchy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-09
Dose 2 — Moderna
2021-02-09
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Diarrhea

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-23
Survey response — day 14, dose 2
MedDRA: Blood pressure increased, Ear discomfort, Fatigue, Feeling abnormal, Presyncope, Somnolence — Feeling: Fair · Be unable to do your normal daily activities

Free text: Ive been feeling extremely fatigued; sleeping more than usual. My BP has been elevated. My ears get clogged on/off throughout the day, like Im going to pass out. My head feels a little foggy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Fair

Free text: Still experiencing extreme fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — day 28, dose 2
MedDRA: Ear discomfort, Fatigue, Head discomfort — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: My ears get plugged/clogged several times throughout the week & feels as though theres a lot of pressure in both ears (and head) along with pulsations. Still experiencing intense exhaustion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-27
Call successful
Does not wish to fill out VAERS report
2022-01-07
Dose 3 — Moderna
2022-01-07
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-01-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-01-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2022-01-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness, Abdominal pain

Adult check-in
2022-01-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2022-01-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling, Itching · Headache

Adult check-in
2022-01-14
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain, Swelling · Chills, Nausea, Diarrhea

Adult check-in
2022-01-21
Survey response — day 14, dose 3
MedDRA: Headache — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: A headache for 3+ days. Pretty debilitating.

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-02-06
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-11
Survey response — day 35, dose 3
MedDRA: Hypoaesthesia — Feeling: Fair

Free text: numbness in different parts of my body

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-09	Moderna
3	2022-01-07	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 2 — day 7, dose 1

2021-01-19

Systemic reaction (other): I felt pain on the right side of my chest - it lasted for about 2 hours. The rash on the vaccine site came back and its really itchy.

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): Sore throat

2021-02-15

Systemic reaction (other): Dizziness

Release 4 — day 14, dose 2

2021-02-23

Symptoms: Ive been feeling extremely fatigued; sleeping more than usual. My BP has been elevated. My ears get clogged on/off throughout the day, like Im going to pass out. My head feels a little foggy.

Release 4 — day 21, dose 2

2021-03-02

Symptoms: Still experiencing extreme fatigue.

Release 5 — day 28, dose 2

2021-03-09

Symptoms: My ears get plugged/clogged several times throughout the week & feels as though theres a lot of pressure in both ears (and head) along with pulsations. Still experiencing intense exhaustion.

Release 11 — day 14, dose 3

2022-01-21

Symptoms: A headache for 3+ days. Pretty debilitating.

Release 11 — day 35, dose 3

2022-02-11

Symptoms: numbness in different parts of my body

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	Blood pressure increased	✓	✓	✓
SD	Ear discomfort	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Head discomfort	✓	✓	✓
SD	Headache	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Presyncope	✓	✓	✓
SD	Somnolence	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Injection site rash	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓

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