75Z-23751-45422

3 vaccinations 12 coded responses 38 check-ins 12 free-text entries 6 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 810 / CO
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — day 0, dose 1
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Diarrhea

Adult check-in
2021-01-08
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Insomnia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-08
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-01-10
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Insomnia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-18
Survey response — day 14, dose 1
MedDRA: Headache, Injection site discolouration, Toothache — Feeling: Fair

Free text: Dark area where injection was received. Teeth pain. Daily headaches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Survey response — day 21, dose 1
MedDRA: Chest pain, Chiropractic, Headache — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Pericardial catch syndrome, daily headaches. · Healthcare visit (other): Chiropractic care

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-29
Dose 2 — Moderna
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-01
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 work, Be unable to do your normal daily activities

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · 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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-04-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-05-02
Survey response — 3 months, dose 2
MedDRA: Dizziness, Ear pain, Sinus pain — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Severe sinus pain. Ear pain. Dizzying spells.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
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)
2021-08-01
Survey response — 6 months, dose 2
MedDRA: Abnormal menstrual clots, Contusion, Gastrointestinal disorder, Heavy menstrual bleeding, Impaired healing, Scratch, Urogenital disorder — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Period extremely heavy and lots of large clot discharge. Bruises that won't heal. Scratches that won't heal. GI and GU issues.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-01
Report sent to call center — 6 months, dose 2
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)
2021-08-06
Call 2 — Left Voicemail
2021-12-09
Dose 3 — Moderna
2021-12-09
Health check-in — day 0, dose 3
Feeling: Poor · Site: Swelling, Itching · Fever · Fatigue or tiredness

Adult check-in
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-13
Survey response — days 1–6 daily, dose 3
MedDRA: Dysgeusia — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Free text: Everything tastes metallic, even water which shouldn't have a taste. Started the day after the booster

MedDRA releases: 2024-11 · check-in free text available
2021-12-14
Survey response — days 1–6 daily, dose 3
MedDRA: Dysgeusia — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: Metallic taste in my mouth

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Survey response — days 1–6 daily, dose 3
MedDRA: Dysgeusia — Feeling: Good · Site: Pain, Redness, Swelling, Itching

Free text: Things taste metallic

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-12-23
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-30
Survey response — day 21, dose 3
MedDRA: Insomnia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Insomnia

MedDRA releases: 2024-11 · check-in free text available
2022-01-06
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-13
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-01-20
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-12
Survey response — 3 months, dose 3
MedDRA: Headache — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Consistent headaches

MedDRA releases: 2024-11 · check-in free text available
2022-03-12
Report sent to call center — 3 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-09
Survey response — 6 months, dose 3
MedDRA: COVID-19 — 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 · Outpatient clinic or urgent care clinic visit

Free text: Got covid

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-10
Call 1 — Could Not Reach Participant
2022-06-10
Call 1 — Could Not Reach Participant
2022-06-10
Call 1 — Could Not Reach Participant
2022-06-10
Call 1 — Could Not Reach Participant
2022-06-10
Call 1 — Could Not Reach Participant
2022-06-10
Call 1 — Could Not Reach Participant
2022-06-15
Call successful
Does not wish to fill out VAERS report
2022-12-11
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-01-29	Moderna
3	2021-12-09	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-08	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-01-25	Successful 2021-04-05	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-05-02	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-01	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-12	Successful 2022-03-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-09	Successful 2022-06-15	Does not wish to fill out VAERS report

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-08

Systemic reaction (other): Insomnia

2021-01-10

Systemic reaction (other): Insomnia

Release 2 — day 14, dose 1

2021-01-18

Symptoms: Dark area where injection was received. Teeth pain. Daily headaches.

Release 2 — day 21, dose 1

2021-01-25

Symptoms: Pericardial catch syndrome, daily headaches.

Healthcare visit (other): Chiropractic care

Release 8 — 3 months, dose 2

2021-05-02

Symptoms: Severe sinus pain. Ear pain. Dizzying spells.

Release 9 — 6 months, dose 2

2021-08-01

Symptoms: Period extremely heavy and lots of large clot discharge. Bruises that won't heal. Scratches that won't heal. GI and GU issues.

Release 10 — days 1–6 daily, dose 3

2021-12-13

Systemic reaction (other): Everything tastes metallic, even water which shouldn't have a taste. Started the day after the booster

2021-12-14

Systemic reaction (other): Metallic taste in my mouth

2021-12-15

Systemic reaction (other): Things taste metallic

Release 10 — day 21, dose 3

2021-12-30

Symptoms: Insomnia

Release 11 — 3 months, dose 3

2022-03-12

Symptoms: Consistent headaches

Release 11 — 6 months, dose 3

2022-06-09

Symptoms: Got 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
HCVO	Chiropractic	✓	✓	✓
SD	Abnormal menstrual clots	✓	·	✓
SD	Chest pain	✓	✓	✓
SD	Contusion	✓	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Gastrointestinal disorder	✓	·	✓
SD	Headache	✓	✓	✓
SD	Heavy menstrual bleeding	✓	·	✓
SD	Impaired healing	✓	·	✓
SD	Injection site discolouration	✓	✓	✓
SD	Insomnia	·	·	✓
SD	Scratch	✓	·	✓
SD	Sinus pain	✓	✓	✓
SD	Toothache	✓	✓	✓
SD	Urogenital disorder	✓	·	✓
SRO	Dysgeusia	·	·	✓
SRO	Insomnia	✓	✓	✓

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