6SL-32826-35941

3 vaccinations 6 coded responses 26 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 930 / CA
Registered: 2021-04-20

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

YPV-20229-62891 Child or adolescent in my care · Male · 2021-06-15

LVY-39178-77877 Child or adolescent in my care · Female · 2021-06-22

7WF-31875-42808 Child or adolescent in my care · Male · 2022-01-04

Timeline

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

2021-04-19
Dose 1 — Moderna
2021-04-20
Registered in v-safe
2021-04-20
Survey response — days 1–6 daily, dose 1
MedDRA: Brain fog, Feeling abnormal — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal — Feeling: Fair · Fatigue or tiredness

Free text: Still some brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-17
Dose 2 — Moderna
2021-05-17
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-19
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site warmth — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Warmth at injection site-yesterday too

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-05-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-25
Health check-in — day 7, dose 2
Feeling: Fair · None

Adult check-in
2021-06-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-28
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-16
Survey response — 3 months, dose 2
MedDRA: Chest discomfort, Ear discomfort — Feeling: Good

Free text: Plugged ears, occasional chest tightness

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-01-24
Dose 3 — Moderna
2022-01-24
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-01-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, 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
2022-02-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-02-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-03-03
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-03-10
Survey response — day 42, dose 3
MedDRA: Condition aggravated, Pre-existing disease, Pruritus, Tenderness, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Old scar (from a previous vaccination 10 years ago) on same shoulder as Covid vaccination has become tender and occasionally itchy, slightly larger, more prominent. · Healthcare visit (other): I will see my primary doctor to have it checked out

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-25
Survey response — 6 months, dose 3
MedDRA: Chills, Cough, Fatigue, Pain, Paranasal sinus discomfort, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Unevaluable event — 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

Free text: Symptoms: Severe fatigue, fever high of 103, body aches, chills, congestion, runny nose, sinus pressure, occasional dry cough. · Healthcare visit (other): Sent message to primary care provider-did not visit

MedDRA releases: 2024-11 · check-in free text available
2022-07-25
Report sent to call center — 6 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

1 call case(s)
2022-07-26
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-19	Moderna
2	2021-05-17	Moderna
3	2022-01-24	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-20

Systemic reaction (other): Brain fog

2021-04-23

Systemic reaction (other): Still some brain fog

Release 8 — days 1–6 daily, dose 2

2021-05-19

Systemic reaction (other): Warmth at injection site-yesterday too

Release 9 — 3 months, dose 2

2021-08-16

Symptoms: Plugged ears, occasional chest tightness

Release 11 — day 42, dose 3

2022-03-10

Symptoms: Old scar (from a previous vaccination 10 years ago) on same shoulder as Covid vaccination has become tender and occasionally itchy, slightly larger, more prominent.

Healthcare visit (other): I will see my primary doctor to have it checked out

Release 12 — 6 months, dose 3

2022-07-25

Symptoms: Severe fatigue, fever high of 103, body aches, chills, congestion, runny nose, sinus pressure, occasional dry cough.

Healthcare visit (other): Sent message to primary care provider-did not visit

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	Unevaluable event	·	·	✓
SD	Chest discomfort	✓	·	✓
SD	Chills	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	Ear discomfort	✓	·	✓
SD	Fatigue	·	·	✓
SD	Pain	·	·	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Tenderness	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓

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