6FJ-20613-97429

4 vaccinations 10 coded responses 21 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 144 / NY
Registered: 2021-01-26

Relationship: Self
Race: White
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
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Survey response — day 7, dose 1
MedDRA: Oral mucosal eruption, Rash — Feeling: Good · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: For three days I had a rash inside mouth , abd a slight rash on my bottom. Today all is clear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — day 14, dose 1
MedDRA: Headache, Insomnia — Feeling: Good

Free text: So about the 5th-and 6th day after the first vaccination I had a slight headache when I was awake two days in a row. I did nit have the headache when I was I n bed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-23
Survey response — day 28, dose 1
MedDRA: Feeling hot, Paraesthesia — Feeling: Good

Free text: My left thumb, index finger and middle finger of my left hand are getting severe tingling like blood isnt getting to those extremities.And each of those digits are warm in the usual way.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Dose 2 — Moderna
2021-03-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-03
Survey response — day 35, dose 2
MedDRA: Headache, Rhinorrhoea — Feeling: Fair

Free text: Slight headache and runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-31
Survey response — 3 months, dose 2
MedDRA: Flank pain, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I feel a pain in my right side that gas been there for four weeks by improving. Felt like ami injured a rib · Healthcare visit (other): Regular pcp appt abd check up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2022-02-25
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-15
Dose 4 — Moderna
2022-04-15
Call successful
Not applicable - Accidental Reporting
2022-04-30
Survey response — 6 months, dose 3
MedDRA: Fatigue, Laryngitis, Nasopharyngitis, Throat irritation — Feeling: Poor · 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: Tickle in throat. Head cold , lyrangitis, datigue

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Survey response — day 14, dose 4
MedDRA: Exposure to SARS-CoV-2, Malaise, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities

Free text: Covid Symptoms and exposure between 4/9 and 4/18, tested positive at Walgreens on4/18/22.

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Report sent to call center — 6 months, dose 3
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)
2022-05-03
Call 1 — Requested Callback
2022-05-03
Callback requested for
04:30PM ET
2022-05-03
Call successful
Completed over the phone
2022-05-08
Survey response — day 21, dose 4
MedDRA: Cough, Nasopharyngitis, Pre-existing disease, Sneezing — Feeling: Fair

Free text: Allergy sneezes and cough and Cold like symotins

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-28
Survey response — day 42, dose 4
MedDRA: Angina pectoris, Condition aggravated, Cough, Eye discharge, Pre-existing disease, Rhinorrhoea, Sneezing — Feeling: Fair

Free text: Heart pain and allergy attacks of violent sneezing and coughing and runny nose and eyes.

MedDRA releases: 2024-11 · check-in free text available
2022-07-15
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-14
Survey response — 6 months, dose 4
MedDRA: Eczema, Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Rashes. More severe than usual . Diagnosed as exema

MedDRA releases: 2024-11 · check-in free text available
2022-10-14
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-17
Call successful
Reported to VAERS during previous contact from GDIT
2023-04-17
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-25	Moderna
3	2021-10-25	Moderna	No
4	2022-04-15	Moderna	No

Call center

3 call center cases

3 successful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 3 — day 7, dose 1

2021-02-01

Systemic reaction (other): For three days I had a rash inside mouth , abd a slight rash on my bottom. Today all is clear

Release 4 — day 14, dose 1

2021-02-10

Symptoms: So about the 5th-and 6th day after the first vaccination I had a slight headache when I was awake two days in a row. I did nit have the headache when I was I n bed.

Release 4 — day 28, dose 1

2021-02-23

Symptoms: My left thumb, index finger and middle finger of my left hand are getting severe tingling like blood isnt getting to those extremities.And each of those digits are warm in the usual way.

Release 6 — day 35, dose 2

2021-04-03

Symptoms: Slight headache and runny nose

Release 8 — 3 months, dose 2

2021-05-31

Symptoms: I feel a pain in my right side that gas been there for four weeks by improving. Felt like ami injured a rib

Healthcare visit (other): Regular pcp appt abd check up

Release 11 — day 14, dose 4

2022-04-30

Symptoms: Covid Symptoms and exposure between 4/9 and 4/18, tested positive at Walgreens on4/18/22.

Release 11 — 6 months, dose 3

2022-04-30

Symptoms: Tickle in throat. Head cold , lyrangitis, datigue

Release 11 — day 21, dose 4

2022-05-08

Symptoms: Allergy sneezes and cough and Cold like symotins

Release 11 — day 42, dose 4

2022-05-28

Symptoms: Heart pain and allergy attacks of violent sneezing and coughing and runny nose and eyes.

Release 12 — 6 months, dose 4

2022-10-14

Symptoms: Rashes. More severe than usual . Diagnosed as exema

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	Office visit	✓	✓	✓
SD	Angina pectoris	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	Eczema	·	·	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Eye discharge	·	·	✓
SD	Fatigue	·	·	✓
SD	Feeling hot	✓	✓	✓
SD	Flank pain	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Laryngitis	·	·	✓
SD	Malaise	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Paraesthesia	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sneezing	·	·	✓
SD	Throat irritation	·	·	✓
SRO	Oral mucosal eruption	✓	✓	✓
SRO	Rash	✓	✓	✓

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