933-78060-67341

4 vaccinations 7 coded responses 31 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 301 / GA
Registered: 2021-03-19

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

2021-03-19
Registered in v-safe
2021-03-19
Dose 1 — Moderna
2021-03-19
Survey response — day 0, dose 1
MedDRA: Dry mouth — Feeling: Good · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dry mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-03
Survey response — day 14, dose 1
MedDRA: Fatigue, Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

Free text: My arm hurt again and I felt very tired last weekend.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-16
Dose 2 — Moderna
2021-04-16
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Contusion — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Chills, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Bruising

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-04-25
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-07
Survey response — day 21, dose 2
MedDRA: Injection site rash — Feeling: Good

Free text: Rash at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-17
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-15
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-24
Dose 3 — Moderna
2022-05-25
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-16
Dose 4 — Pfizer-BioNTech
2022-10-14
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-28
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-16
Survey response — 3 months, dose 4
MedDRA: Abortion spontaneous — 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 · Emergency room or emergency department visit

Free text: Miscarriage

MedDRA releases: 2024-11 · check-in free text available
2022-12-16
Report sent to call center — 3 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-12-19
Call 1 — Left Voicemail
2022-12-22
Call successful
Participant prefers to complete VAERS report online
2023-03-17
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-19	Moderna
2	2021-04-16	Moderna
3	2021-11-24	Moderna	No
4	2022-09-16	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-12-16	Successful 2022-12-22	Participant prefers to complete VAERS report online

Free text

Release 5 — day 0, dose 1

2021-03-19

Systemic reaction (other): Dry mouth

Release 6 — day 14, dose 1

2021-04-03

Symptoms: My arm hurt again and I felt very tired last weekend.

Release 7 — days 1–6 daily, dose 2

2021-04-17

Systemic reaction (other): Dizziness

2021-04-18

Systemic reaction (other): Dizzy

2021-04-21

Systemic reaction (other): Bruising

Release 8 — day 21, dose 2

2021-05-07

Symptoms: Rash at injection site

Release 12 — 3 months, dose 4

2022-12-16

Symptoms: Miscarriage

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	Abortion spontaneous	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SRO	Contusion	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dry mouth	✓	✓	✓

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