75J-54389-39011

4 vaccinations 5 coded responses 35 check-ins 5 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 863 / AZ
Registered: 2020-12-24

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

Registered dependents

4H9-14948-42649 Child or adolescent in my care · Male · 2022-07-21

Timeline

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

2020-12-23
Dose 1 — Moderna
2020-12-24
Registered in v-safe
2020-12-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2020-12-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2020-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-20
Dose 2 — Moderna
2021-01-21
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Swollen lymph nodes (axilla and inguinal)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Poor sleep

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 35, dose 2
Feeling: Good

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

Adult check-in
2021-04-21
Survey response — 3 months, dose 2
MedDRA: Bronchitis, SARS-CoV-2 test negative, Sinusitis — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visit

Free text: Bronchitis and sinusitis. Covid/RSV negative though

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
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)
2021-07-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-09
Dose 3 — Moderna
2022-01-20
Survey response — 12 months, dose 2
MedDRA: Headache, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headache x 7 days. Son is covid positive. I tested negative twice.

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Call 1 — Left Voicemail
2022-09-13
Dose 4 — Moderna
Co-administered: Flu
2022-09-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-20
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-09-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-04
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-11
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-18
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-25
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-13
Survey response — 3 months, dose 4
MedDRA: COVID-19, Headache, Pregnancy — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Pregnant. Headache. Covid.

MedDRA releases: 2024-11 · check-in free text available
2023-03-14
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-01-20	Moderna
3	2021-11-09	Moderna	No
4	2022-09-13	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-04-21	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 2

2021-01-21

Systemic reaction (other): Swollen lymph nodes (axilla and inguinal)

2021-01-22

Systemic reaction (other): Poor sleep

Release 7 — 3 months, dose 2

2021-04-21

Symptoms: Bronchitis and sinusitis. Covid/RSV negative though

Release 10 — 12 months, dose 2

2022-01-20

Symptoms: Headache x 7 days. Son is covid positive. I tested negative twice.

Release 12 — 3 months, dose 4

2022-12-13

Symptoms: Pregnant. Headache. Covid.

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	Bronchitis	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Headache	·	·	✓
SD	Pregnancy	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓

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