6T4-49510-34305

5 vaccinations 13 coded responses 35 check-ins 12 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 206 / MD
Registered: 2021-01-17

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

2021-01-13
Dose 1 — Moderna
2021-01-17
Registered in v-safe
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · Site: Redness · None

Adult check-in
2021-01-27
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
2021-02-10
Dose 2 — Moderna
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinorrhoea — Feeling: Good · Site: Redness, Swelling · Fatigue or tiredness

Free text: Sniffles, runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-02-20
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness · None

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

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

Adult check-in
2021-03-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-17
Survey response — day 35, dose 2
MedDRA: Fatigue, Headache, Hypersensitivity, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Allergies to tree pollens. Runny nose, headaches, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus infection

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-21
Call 1 — Left Voicemail
2021-09-13
Dose 3 — Moderna
2021-10-26
Survey response — day 42, dose 3
MedDRA: Sinusitis, Urinary tract infection — Feeling: Good · 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: UTI and sinus infection

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Report sent to call center — day 42, 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)
2021-10-27
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-15
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-17
Survey response — 6 months, dose 3
MedDRA: SARS-CoV-2 test negative, Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus infection but not COVID. Took cefuroxime 10 days and got better. I am 78 so still wearing mask to grocery store, etc.

MedDRA releases: 2024-11 · check-in free text available
2022-03-17
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-19
Call successful
Does not wish to fill out VAERS report
2022-05-04
Dose 4 — Moderna
2022-05-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2022-05-07
Survey response — days 1–6 daily, dose 4
MedDRA: Contusion, Erythema — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lasr night long area redness from underarm near armpit extending almost to bottom of elbow. Today noon, now looks like a long severe bruise.

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Survey response — days 1–6 daily, dose 4
MedDRA: Sensitive skin, Skin discolouration — Feeling: Poor · Site: Swelling, Itching · Fatigue or tiredness · Be unable to work or attend school

Free text: Area of underarm atill sensitive, now turning darker like a bruise.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Survey response — days 1–6 daily, dose 4
MedDRA: Contusion — Feeling: Good

Free text: Bruise underarm is slowly going away

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-18
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-06-02
Survey response — day 28, dose 4
MedDRA: Fatigue, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Fatigue. Very very tired all of the time. Doctor has ordered blood work. No temp. · Healthcare visit (other): In person doc visit

MedDRA releases: 2024-11 · check-in free text available
2022-06-02
Report sent to call center — day 28, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-12
Survey response — day 35, dose 4
MedDRA: Insomnia, Limb injury, Pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Continuing issues due to leg injuries on April 12. Unrelenting pain & difficulty sleeping unrelated to vaccination. Will seek help from vascular physician this week.

MedDRA releases: 2024-11 · check-in free text available
2022-06-15
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-09-28
Dose 5 — Pfizer-BioNTech
2022-09-29
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-10-01
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-10-03
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Swelling · None

Adult check-in
2022-10-07
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-12
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-21
Survey response — day 21, dose 5
MedDRA: Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue, headache.

MedDRA releases: 2024-11 · check-in free text available
2022-12-29
Survey response — 3 months, dose 5
MedDRA: Brain fog, Fatigue, Office visit, Pain, Pre-existing disease, SARS-CoV-2 test negative — 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 · Hospitalization

Free text: Symptoms: I have chronic Lyme disease & am experiencing pain, brain fog and exhaustion. I am having rocephin shots. COVID test negative · Healthcare visit (other): Regular office visit

MedDRA releases: 2024-11 · check-in free text available
2022-12-29
Report sent to call center — 3 months, 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

Hospitalization · 1 call case(s)
2022-12-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-29
Survey response — 6 months, dose 5
MedDRA: Fatigue, Office visit, Pain in extremity, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-03-29
Report sent to call center — 6 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2023-03-30
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna
2	2021-02-10	Moderna
3	2021-09-13	Moderna	No
4	2022-05-04	Moderna	No
5	2022-09-28	Pfizer-BioNTech	No

Call center

6 call center cases

5 successful · 1 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Sniffles, runny nose

Release 5 — day 35, dose 2

2021-03-17

Symptoms: Allergies to tree pollens. Runny nose, headaches, fatigue

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: Sinus infection

Release 10 — day 42, dose 3

2021-10-26

Symptoms: UTI and sinus infection

Release 11 — 6 months, dose 3

2022-03-17

Symptoms: Sinus infection but not COVID. Took cefuroxime 10 days and got better. I am 78 so still wearing mask to grocery store, etc.

Release 11 — days 1–6 daily, dose 4

2022-05-07

Systemic reaction (other): Lasr night long area redness from underarm near armpit extending almost to bottom of elbow. Today noon, now looks like a long severe bruise.

2022-05-08

Systemic reaction (other): Area of underarm atill sensitive, now turning darker like a bruise.

2022-05-10

Systemic reaction (other): Bruise underarm is slowly going away

Release 11 — day 28, dose 4

2022-06-02

Symptoms: Fatigue. Very very tired all of the time. Doctor has ordered blood work. No temp.

Healthcare visit (other): In person doc visit

Release 12 — day 35, dose 4

2022-06-12

Symptoms: Continuing issues due to leg injuries on April 12. Unrelenting pain & difficulty sleeping unrelated to vaccination. Will seek help from vascular physician this week.

Release 12 — day 21, dose 5

2022-10-21

Symptoms: Fatigue, headache.

Release 12 — 3 months, dose 5

2022-12-29

Symptoms: I have chronic Lyme disease & am experiencing pain, brain fog and exhaustion. I am having rocephin shots. COVID test negative

Healthcare visit (other): Regular office 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	Office visit	·	·	✓
SD	Brain fog	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Insomnia	·	·	✓
SD	Limb injury	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinusitis	✓	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Contusion	·	·	✓
SRO	Erythema	·	·	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sensitive skin	·	·	✓
SRO	Skin discolouration	·	·	✓

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