76R-99750-47913

5 vaccinations 11 coded responses 46 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 787 / TX
Registered: 2021-01-15

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

Registered dependents

K2G-18623-54694 Child or adolescent in my care · Male · 2022-06-27

ZJG-15802-20152 Child or adolescent in my care · Male · 2022-06-27

GSE-23681-08410 Child or adolescent in my care · Female · 2023-03-31

Timeline

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

2021-01-15
Registered in v-safe
2021-01-15
Dose 1 — Moderna
2021-01-15
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Survey response — day 14, dose 1
MedDRA: Cyst, Mastitis, Medical counselling, Nasal congestion, Ocular discomfort, Pre-existing disease, Rhinorrhoea — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Allergies - pressure behind my eyes, stuffy/runny nose.Cyst on my armMastisis · Healthcare visit (other): Phone call to request prescription

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinorrhoea, Sneezing — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Probable Allergies- runny nose and sneezing

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: Good · Site: Pain · Fatigue or tiredness

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

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

Adult check-in
2021-02-19
Survey response — day 7, dose 2
MedDRA: Headache, Insomnia — Feeling: Fair · Headache

Free text: Headache from lack of sleep. Live in texas.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Survey response — day 21, dose 2
MedDRA: Breast tenderness, Headache, Mastitis, Medical counselling, Pain — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Mastitis- achy, breast tenderness Headache · Healthcare visit (other): Call, talk to nurse to get prescription for infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-20
Health check-in — day 35, dose 2
Feeling: Good

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

Adult check-in
2021-05-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-05-25
Call 2 — Left Voicemail
2021-08-15
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-13
Dose 3 — Moderna
2022-02-12
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-08-01
Survey response — day 7, dose 2, under 3
MedDRA: Irritability, Pyrexia, Somnolence — Feeling: Good

Free text: Night of/day after 2nd vaccine had a low grade fever, sleepiness, and a little fussiness

MedDRA releases: 2024-11 · check-in free text available
2022-08-08
Dose 4 — Moderna
2022-08-08
Survey response — day 0, dose 4
MedDRA: Pregnancy — Feeling: Good · Site: Pain

Free text: Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-08-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2022-08-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-08-12
Survey response — days 1–6 daily, dose 4
MedDRA: Ocular discomfort, Pre-existing disease — Feeling: Fair

Free text: Allergy pressure behind my eyes.

MedDRA releases: 2024-11 · check-in free text available
2022-08-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-08-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-08-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-09-05
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-09-12
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-09-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-11-07
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-12-30
Dose 5 — Moderna
2022-12-31
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-01-01
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-01-02
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2023-01-03
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2023-01-05
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2023-01-08
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2023-01-13
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2023-01-20
Survey response — day 21, dose 5
MedDRA: Muscle spasms, Oropharyngeal pain, Paranasal sinus discomfort — Feeling: Fair

MedDRA releases: 2024-11
2023-01-29
Survey response — day 28, dose 5
MedDRA: Ocular discomfort, Oropharyngeal pain, Pain, Paranasal sinus discomfort, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Good

MedDRA releases: 2024-11
2023-02-05
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2023-02-10
Survey response — day 42, dose 5
MedDRA: Nasal congestion, Oropharyngeal pain, Paranasal sinus discomfort, Pyrexia, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-03-31
Survey response — 3 months, dose 5
MedDRA: Sinusitis — Feeling: Good · 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

MedDRA releases: 2024-11
2023-03-31
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-03
Call 1 — Left Voicemail
2023-04-03
Call 1 — Left Voicemail
2023-04-03
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-11-13	Moderna	No
4	2022-08-08	Moderna	No
5	2022-12-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-29	Unsuccessful
2021-03-05	Unsuccessful
2023-03-31	Unsuccessful

Free text

Release 3 — day 14, dose 1

2021-01-29

Symptoms: Allergies - pressure behind my eyes, stuffy/runny nose.Cyst on my armMastisis

Healthcare visit (other): Phone call to request prescription

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Probable Allergies- runny nose and sneezing

Release 4 — day 7, dose 2

2021-02-19

Systemic reaction (other): Headache from lack of sleep. Live in texas.

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Mastitis- achy, breast tenderness Headache

Healthcare visit (other): Call, talk to nurse to get prescription for infection

Release 12 — day 0, dose 4

2022-08-08

Systemic reaction (other): Pregnancy

Release 12 — days 1–6 daily, dose 4

2022-08-12

Systemic reaction (other): Allergy pressure behind my eyes.

Release 12 (Under 3) — day 7, dose 2, under 3

2022-08-01

Systemic reaction (other): Night of/day after 2nd vaccine had a low grade fever, sleepiness, and a little fussiness

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	Medical counselling	✓	✓	✓
SD	Breast tenderness	✓	✓	✓
SD	Cyst	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Mastitis	✓	✓	✓
SD	Muscle spasms	·	·	✓
SD	Nasal congestion	✓	✓	✓
SD	Ocular discomfort	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Headache	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Irritability	·	·	✓
SRO	Ocular discomfort	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pregnancy	·	·	✓
SRO	Pyrexia	·	·	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Somnolence	·	·	✓

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