6HL-20833-44925

5 vaccinations 19 coded responses 59 check-ins 16 free-text entries 8 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 787 / TX
Registered: 2021-02-12

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-01-14
Dose 1 — Moderna
2021-02-12
Registered in v-safe
2021-02-12
Dose 2 — Moderna
2021-02-12
Survey response — day 0, dose 2
MedDRA: Abdominal distension, Hypersensitivity, Nausea, Rash, Self-medication — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Note: just signed up after second shot but got facial rash immediately after both shots and slight nausea and bloating. Immediate reactions after first shot were much worse allergic reactions so took Benadryl before second shot on dr recs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Asthenia, Chills, Eye pain, Musculoskeletal stiffness, Pain in extremity, Pyrexia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · 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: Eye pain & high fever which Tylenol does not help. Much worse today than yesterday. Is 103+ fever a normal reaction? Plus stiff neck and pain running down from shoulder to hand on side of injection. Chills :- very weak getting up.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Report sent to call center — days 1–6 daily, dose 2
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)
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-26
Survey response — day 14, dose 2
MedDRA: Sinusitis — Feeling: Good · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 14, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Survey response — day 21, dose 2
MedDRA: Sinusitis — Feeling: Good · Be unable to do your normal daily activities

Free text: Sinus infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 28, dose 2
MedDRA: Sinusitis — Feeling: Fair · Be unable to work

Free text: Worsening sinus infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-15
Survey response — 3 months, dose 2
MedDRA: Cough, Dyspnoea, Pneumonia, Pyrexia, SARS-CoV-2 test false negative, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Cough, fever of 100 plus, trouble breathing. Diagnosed fluid in lungs probably atypical pneumonia. Levaquin plus Advair for week. Better now but still cough. Negative Covid & flu test.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Report sent to call center — 3 months, dose 2
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)
2021-08-03
Call 2 — Left Voicemail
2021-08-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-30
Dose 3 — Moderna
2021-10-30
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Arthritis like severe pain in left hip

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Joint pain left hip and now foot

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-06
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-20
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-11
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-29
Survey response — 3 months, dose 3
MedDRA: Migraine — Feeling: Fair · Be unable to do your normal daily activities

Free text: Migraine

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-13
Dose 4 — Moderna
2022-05-13
Health check-in — day 0, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-05-14
Survey response — days 1–6 daily, dose 4
MedDRA: Concussion, Fall, Head injury, Headache, Swelling — 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: Really bad headache. Fell & hit my head 5 days ago. Mild concussion. Headache went away after a day but came back at the spot where I hit really bad after the shot. Assume swelling there.

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · 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

Adult check-in
2022-05-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-05-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Itching · Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site

Adult check-in
2022-05-20
Health check-in — day 7, dose 4
Feeling: Good · Site: Redness, Swelling · Fatigue or tiredness, Diarrhea

Adult check-in
2022-05-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-17
Survey response — day 35, dose 4
MedDRA: Appendicitis, Emergency care — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: In ER for appendicitis.

MedDRA releases: 2024-11 · check-in free text available
2022-06-17
Report sent to call center — day 35, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-06-21
Call successful
Participant prefers to complete VAERS report online
2022-06-21
Call successful
Participant prefers to complete VAERS report online
2022-06-21
Call successful
Participant prefers to complete VAERS report online
2022-06-21
Call successful
Participant prefers to complete VAERS report online
2022-06-24
Survey response — day 42, dose 4
MedDRA: Appendicectomy, Appendicitis, Cardiomegaly, Emergency care, Pulmonary oedema — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Emergency appendicitis surgery Friday June 17. Monday back in ER for fluid in lungs & enlarged heart which did not have a month ago.

MedDRA releases: 2024-11 · check-in free text available
2022-06-24
Report sent to call center — day 42, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-06-27
Call 1 — Left Voicemail
2022-06-27
Call 1 — Left Voicemail
2022-06-27
Call 1 — Left Voicemail
2022-06-27
Call 1 — Left Voicemail
2022-06-27
Call 1 — Left Voicemail
2022-06-27
Call successful
Participant prefers to complete VAERS report online
2022-08-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-11
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-12-15
Dose 5 — Moderna
2022-12-15
Health check-in — day 0, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-12-16
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-12-17
Survey response — days 1–6 daily, dose 5
MedDRA: Arthralgia, Hypotension, Respiration abnormal, Syncope — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · 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: Extreme joint pain; low blood pressure; fainted twice; quit breathing once after fainting!

MedDRA releases: 2024-11 · check-in free text available
2022-12-17
Report sent to call center — days 1–6 daily, 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)
2022-12-18
Survey response — days 1–6 daily, dose 5
MedDRA: Adverse reaction, Arthralgia, Medical counselling — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · 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: Systemic reaction (other): Extreme joint pain. · Healthcare visit (other): Checked in with doctor via email since had severe reactions earlier

MedDRA releases: 2024-11 · check-in free text available
2022-12-18
Report sent to call center — days 1–6 daily, 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)
2022-12-19
Survey response — days 1–6 daily, dose 5
MedDRA: Adverse reaction, Frustration tolerance decreased, Pre-existing disease — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · 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: Systemic reaction (other): Frustrated since CDC & Moderns cannot give me info on excipient sources sufficient for me to determine why allergic reaction!!!!! · Healthcare visit (other): Please require more info from Vaccine providers about excipients and what sources of excipients are for those of us with allergies and adverse reactions!!!!

MedDRA releases: 2024-11 · check-in free text available
2022-12-19
Report sent to call center — days 1–6 daily, 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)
2022-12-19
Call 1 — Left Voicemail
2022-12-19
Call successful
Completed over the phone
2022-12-20
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-12-20
Call successful
Reported to VAERS during previous contact from GDIT
2022-12-21
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-12-22
Health check-in — day 7, dose 5
Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-12-29
Survey response — day 14, dose 5
MedDRA: Abdominal pain upper, Arthralgia, Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stomach ache plus diarrhea. Still have joint pain in shoulders from Vaccine. Has not gone away.

MedDRA releases: 2024-11 · check-in free text available
2023-01-05
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2023-01-12
Survey response — day 28, dose 5
MedDRA: Mast cell activation syndrome, Mast cell degranulation present, Reaction to excipient — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-01-19
Survey response — day 35, dose 5
MedDRA: Hypersensitivity, Mast cell degranulation present, Migraine — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-01-26
Survey response — day 42, dose 5
MedDRA: Arthralgia, Mast cell degranulation present — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-03-16
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-06-15
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-12	Moderna
3	2021-10-30	Moderna	No
4	2022-05-13	Moderna	No
5	2022-12-15	Moderna	No

Call center

8 call center cases

8 successful

VAERS report filed, before or during a call: 3

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 0, dose 2

2021-02-12

Systemic reaction (other): Note: just signed up after second shot but got facial rash immediately after both shots and slight nausea and bloating. Immediate reactions after first shot were much worse allergic reactions so took Benadryl before second shot on dr recs.

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Eye pain & high fever which Tylenol does not help. Much worse today than yesterday. Is 103+ fever a normal reaction? Plus stiff neck and pain running down from shoulder to hand on side of injection. Chills :- very weak getting up.

Release 4 — day 14, dose 2

2021-02-26

Symptoms: Sinus infection.

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Sinus infection.

Release 5 — day 28, dose 2

2021-03-12

Symptoms: Worsening sinus infection.

Release 8 — 3 months, dose 2

2021-05-15

Symptoms: Cough, fever of 100 plus, trouble breathing. Diagnosed fluid in lungs probably atypical pneumonia. Levaquin plus Advair for week. Better now but still cough. Negative Covid & flu test.

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): Arthritis like severe pain in left hip

2021-11-02

Systemic reaction (other): Joint pain left hip and now foot

Release 11 — 3 months, dose 3

2022-01-29

Symptoms: Migraine

Release 11 — days 1–6 daily, dose 4

2022-05-14

Systemic reaction (other): Really bad headache. Fell & hit my head 5 days ago. Mild concussion. Headache went away after a day but came back at the spot where I hit really bad after the shot. Assume swelling there.

Release 12 — day 35, dose 4

2022-06-17

Symptoms: In ER for appendicitis.

Release 12 — day 42, dose 4

2022-06-24

Symptoms: Emergency appendicitis surgery Friday June 17. Monday back in ER for fluid in lungs & enlarged heart which did not have a month ago.

Release 12 — days 1–6 daily, dose 5

2022-12-17

Systemic reaction (other): Extreme joint pain; low blood pressure; fainted twice; quit breathing once after fainting!

2022-12-18

Systemic reaction (other): Extreme joint pain.

Healthcare visit (other): Checked in with doctor via email since had severe reactions earlier

2022-12-19

Systemic reaction (other): Frustrated since CDC & Moderns cannot give me info on excipient sources sufficient for me to determine why allergic reaction!!!!!

Healthcare visit (other): Please require more info from Vaccine providers about excipients and what sources of excipients are for those of us with allergies and adverse reactions!!!!

Release 12 — day 14, dose 5

2022-12-29

Symptoms: Stomach ache plus diarrhea. Still have joint pain in shoulders from Vaccine. Has not gone away.

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	Adverse reaction	·	·	✓
HCVO	Medical counselling	·	·	✓
HCVO	Pre-existing disease	·	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Appendicectomy	·	·	✓
SD	Appendicitis	·	·	✓
SD	Arthralgia	·	·	✓
SD	Cardiomegaly	·	·	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Emergency care	·	·	✓
SD	Hypersensitivity	·	·	✓
SD	Mast cell activation syndrome	·	·	✓
SD	Mast cell degranulation present	·	·	✓
SD	Migraine	·	·	✓
SD	Pneumonia	✓	✓	✓
SD	Pulmonary oedema	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Reaction to excipient	·	·	✓
SD	SARS-CoV-2 test false negative	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SRO	Abdominal distension	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Concussion	·	·	✓
SRO	Eye pain	✓	✓	✓
SRO	Fall	·	·	✓
SRO	Frustration tolerance decreased	·	·	✓
SRO	Head injury	·	·	✓
SRO	Headache	·	·	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Hypotension	·	·	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Respiration abnormal	·	·	✓
SRO	Self-medication	✓	✓	✓
SRO	Swelling	·	·	✓
SRO	Syncope	·	·	✓

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