H58-16942-32620

4 vaccinations 20 coded responses 54 check-ins 19 free-text entries 6 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 934 / CA
Registered: 2021-03-22

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

Timeline

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

2021-03-22
Registered in v-safe
2021-03-22
Dose 1 — Moderna
2021-03-22
Health check-in — day 0, dose 1
Feeling: Good · Site: Swelling · Fever · Headache, Muscle or body aches

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Chills, Joint pains, Nausea, Diarrhea, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Chills, Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Headache, Joint pains, Muscle or body aches, Diarrhea

Adult check-in
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-05
Survey response — day 14, dose 1
MedDRA: Body temperature increased, Chills, Cough — Feeling: Fair

Free text: Chills, slight temp w/mild cough (could be allergies- due to environment/pollen count)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — day 21, dose 1
MedDRA: Urinary tract infection — Feeling: Good

Free text: UTI

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Dose 2 — Moderna
2021-04-19
Survey response — day 0, dose 2
MedDRA: Immediate post-injection reaction, Pre-existing disease, Renal pain — Feeling: Good · Site: Swelling · Fever · Headache, Fatigue or tiredness · Be unable to work

Free text: About 30-40 minutes after the 2nd dose, the right kidney area had a moderate sharp pain for a few seconds or so. This could have been residual from finishing a 5-day tx of Macrobid (sp) on 4/17

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · 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: Hyperacusis, Photophobia — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work

Free text: Sensitivity to light and noise

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — days 1–6 daily, dose 2
MedDRA: Hyperacusis, Photophobia — Feeling: Fair · Site: Swelling · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Sensitivity to bright light and loud sounds.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling · Fever · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 7, dose 2
Feeling: Good · Fever · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-05-03
Survey response — day 14, dose 2
MedDRA: Chromaturia, Migraine, Nausea, Vomiting — Feeling: Good · Be unable to do your normal daily activities

Free text: Migraine (7 days), severe nausea & vomiting, unable to keep food in, dark urine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-19
Survey response — 3 months, dose 2
MedDRA: Abdominal distension, Arthralgia, Chills, Diarrhoea, Ear discomfort, Fatigue, Headache, Hyperacusis, Hyperhidrosis, Nausea, Oropharyngeal pain, Pain, Photophobia, Pyrexia, Rash, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diarrhea, chills, body aches, fatigue, nausea, light/sound sensitivity, localized rashes & headaches, joint pain l, body ache, sinusitis feverish, sweaty hands & feet, bloating Sore throat, irritated ear canals,

MedDRA releases: 2024-11 · check-in free text available
2021-07-19
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-27
Call successful
Participant prefers to complete VAERS report online
2021-10-08
Dose 3 — Moderna
Co-administered: Flu
2021-10-08
Survey response — day 0, dose 3
MedDRA: Hyperhidrosis — Feeling: Good · Site: Swelling

Free text: Random sweaty palms and soles of feet

MedDRA releases: 2024-11 · check-in free text available
2021-10-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, 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
2021-10-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, 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
2021-10-11
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Free text: Lymph nodes on left side are swollen (under arm pit & breast)

MedDRA releases: 2024-11 · check-in free text available
2021-10-12
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Received a PCR test due to positive exposure five days ago- results pending. Left lymph nodes of underarm and breast swollen & painful

MedDRA releases: 2024-11 · check-in free text available
2021-10-13
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Swollen lymph nodes under left armpit and left breast

MedDRA releases: 2024-11 · check-in free text available
2021-10-14
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, 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

Free text: Swollen lymph nodes limited to left armpit & breast area

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Health check-in — day 7, dose 3
Feeling: Good · Site: Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-10-22
Survey response — day 14, dose 3
MedDRA: Feeling of body temperature change, Hyperhidrosis — Feeling: Good

Free text: Very sweaty hands and feet (started this week), hot/cold without a temp.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-05
Survey response — day 28, dose 3
MedDRA: Hyperhidrosis, Rash, Unevaluable event, Weight decreased — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Excessive sweating of palms & soles, rash(es)-isolated (left hip, left chest, left hand), overall weight loss. · Healthcare visit (other): Scheduled appointment w/primary on 11/10

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-11
Call successful
Participant prefers to complete VAERS report online
2021-11-12
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-03
Dose 4 — Moderna
2022-04-03
Health check-in — day 0, dose 4
Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches

Adult check-in
2022-04-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-04-05
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-04-06
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-04-07
Survey response — days 1–6 daily, dose 4
MedDRA: Abdominal distension, Dyspepsia, Gastrointestinal disorder, Rash — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Indigestion, bloating, gut issues & rash on joints ( hips)

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Survey response — days 1–6 daily, dose 4
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Free text: Lymph nodes are swollen

MedDRA releases: 2024-11 · check-in free text available
2022-04-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2022-04-10
Health check-in — day 7, dose 4
Feeling: Fair · Site: Swelling · Chills, Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2022-04-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-01
Survey response — day 28, dose 4
MedDRA: Adverse reaction, Condition aggravated, Pre-existing disease, Reaction to previous exposure to any vaccine — Feeling: Fair · 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: Adverse reactions gotten worse after each dose/booster. Gut issues flared up (H. Pylori) twice (2nd round of antibiotics). Been fully symptomatic when exposed but haven't tested positive after known exposure. If this is a known reaction, reach out.

MedDRA releases: 2024-11 · check-in free text available
2022-05-01
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-02
Call 1 — Left Voicemail
2022-05-04
Call successful
Participant prefers to complete VAERS report online
2022-05-08
Survey response — day 35, dose 4
MedDRA: Gastrointestinal disorder, Helicobacter infection, Inflammation — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Acute response to secondary tx for H.Pylori? Tx: prednisone after initial steroid injection on5/2 Endo&Colonoscopy on 6/8, bloodwork on 5/3 & 5/5 autoimmune panel still pending Inflammatory response persist, with mild gastric symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-05-09
Call 2 — Left Voicemail
2022-05-09
Call 1 — Left Voicemail
2022-05-12
Call successful
Participant prefers to complete VAERS report online
2022-05-15
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-04
Survey response — 3 months, dose 4
MedDRA: SARS-CoV-2 test positive — 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: Booster dose or tx for H.Pylori may have amplified adverse reaction. Bloodwork 5/2 & autoimmune panel 5/5. Tested positive for COVID-19 on 5/12

MedDRA releases: 2024-11 · check-in free text available
2022-07-04
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-06
Call 1 — Left Voicemail
2022-07-06
Call 1 — Left Voicemail
2022-07-06
Call 3 — Left Voicemail
2022-07-06
Call 2 — Left Voicemail
2022-07-06
Call 3 — Left Voicemail
2022-10-02
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-04-03
Survey response — 12 months, dose 4
MedDRA: Condition aggravated, Laboratory test abnormal, Pre-existing disease — 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, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-04-03
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-04-04
Call 1 — Requested Callback
2023-04-04
Call 1 — Requested Callback
2023-04-05
Call 2 — Left Voicemail
2023-04-05
Callback requested for
06:00PM ET
2023-04-05
Call 2 — Left Voicemail
2023-04-05
Callback requested for
06:00PM ET

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-22	Moderna
2	2021-04-19	Moderna
3	2021-10-08	Moderna	Flu
4	2022-04-03	Moderna	No

Call center

6 call center cases

4 successful · 2 unsuccessful

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 6 — day 14, dose 1

2021-04-05

Symptoms: Chills, slight temp w/mild cough (could be allergies- due to environment/pollen count)

Release 7 — day 21, dose 1

2021-04-12

Symptoms: UTI

Release 7 — day 0, dose 2

2021-04-19

Systemic reaction (other): About 30-40 minutes after the 2nd dose, the right kidney area had a moderate sharp pain for a few seconds or so. This could have been residual from finishing a 5-day tx of Macrobid (sp) on 4/17

Release 7 — days 1–6 daily, dose 2

2021-04-21

Systemic reaction (other): Sensitivity to light and noise

2021-04-22

Systemic reaction (other): Sensitivity to bright light and loud sounds.

Release 8 — day 14, dose 2

2021-05-03

Symptoms: Migraine (7 days), severe nausea & vomiting, unable to keep food in, dark urine.

Release 9 — 3 months, dose 2

2021-07-19

Symptoms: Diarrhea, chills, body aches, fatigue, nausea, light/sound sensitivity, localized rashes & headaches, joint pain l, body ache, sinusitis feverish, sweaty hands & feet, bloating Sore throat, irritated ear canals,

Release 10 — day 0, dose 3

2021-10-08

Systemic reaction (other): Random sweaty palms and soles of feet

Release 10 — days 1–6 daily, dose 3

2021-10-11

Systemic reaction (other): Lymph nodes on left side are swollen (under arm pit & breast)

2021-10-12

Systemic reaction (other): Received a PCR test due to positive exposure five days ago- results pending. Left lymph nodes of underarm and breast swollen & painful

2021-10-13

Systemic reaction (other): Swollen lymph nodes under left armpit and left breast

2021-10-14

Systemic reaction (other): Swollen lymph nodes limited to left armpit & breast area

Release 10 — day 14, dose 3

2021-10-22

Symptoms: Very sweaty hands and feet (started this week), hot/cold without a temp.

Release 10 — day 28, dose 3

2021-11-05

Symptoms: Excessive sweating of palms & soles, rash(es)-isolated (left hip, left chest, left hand), overall weight loss.

Healthcare visit (other): Scheduled appointment w/primary on 11/10

Release 11 — days 1–6 daily, dose 4

2022-04-07

Systemic reaction (other): Indigestion, bloating, gut issues & rash on joints ( hips)

2022-04-08

Systemic reaction (other): Lymph nodes are swollen

Release 11 — day 28, dose 4

2022-05-01

Symptoms: Adverse reactions gotten worse after each dose/booster. Gut issues flared up (H. Pylori) twice (2nd round of antibiotics). Been fully symptomatic when exposed but haven't tested positive after known exposure. If this is a known reaction, reach out. cut off by CDC

Release 11 — day 35, dose 4

2022-05-08

Symptoms: Acute response to secondary tx for H.Pylori? Tx: prednisone after initial steroid injection on5/2 Endo&Colonoscopy on 6/8, bloodwork on 5/3 & 5/5 autoimmune panel still pending Inflammatory response persist, with mild gastric symptoms

Release 12 — 3 months, dose 4

2022-07-04

Symptoms: Booster dose or tx for H.Pylori may have amplified adverse reaction. Bloodwork 5/2 & autoimmune panel 5/5. Tested positive for COVID-19 on 5/12

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	Unevaluable event	·	·	✓
SD	Abdominal distension	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Arthralgia	·	·	✓
SD	Body temperature increased	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Chromaturia	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Ear discomfort	·	·	✓
SD	Fatigue	·	·	✓
SD	Feeling of body temperature change	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	·	·	✓
SD	Helicobacter infection	·	·	✓
SD	Hyperacusis	·	·	✓
SD	Hyperhidrosis	·	·	✓
SD	Inflammation	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Migraine	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Photophobia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Reaction to previous exposure to any vaccine	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinusitis	·	·	✓
SD	Urinary tract infection	✓	✓	✓
SD	Vomiting	✓	✓	✓
SD	Weight decreased	·	·	✓
SRO	Abdominal distension	·	·	✓
SRO	Dyspepsia	·	·	✓
SRO	Gastrointestinal disorder	·	·	✓
SRO	Hyperacusis	✓	✓	✓
SRO	Hyperhidrosis	·	·	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Photophobia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	·	·	✓
SRO	Renal pain	✓	✓	✓

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