K3Z-24996-48391

1 vaccination 9 coded responses 11 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 354 / AL
Registered: 2021-04-02

Relationship: Self
Race: Black or African American
Ethnicity: N/A

Timeline

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

2021-04-02
Registered in v-safe
2021-04-02
Dose 1 — Moderna
2021-04-03
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Fair · Site: Pain · Headache

Free text: Soreness/pain seems to have spread to approx 2 inch diameter around injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site reaction — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches

Free text: Just the muscles around injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Oropharyngeal pain — Feeling: Fair · Site: Swelling, Itching

Free text: Possibly seasonal allergy related sore throat & general tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease, Pyrexia, Somatic symptom disorder — Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Felt feverish overnight. Better now. Could be psychosomatic. My mother died tuesday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — day 7, dose 1
MedDRA: Fatigue, Hypertension — Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness · Be unable to work

Free text: Higher blood pressure & fatigue. Might be related to other things. Preparing to bury my mother.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-04-24
Survey response — day 21, dose 1
MedDRA: Abortion spontaneous, Ovarian cyst, Vaginal haemorrhage — Feeling: Poor · Be unable to do your normal daily activities

Free text: Possible miscarriage; Ovarian cysts, & abnormal vaginal bleeding.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Survey response — day 42, dose 1
MedDRA: Unevaluable event — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Miscarriage & Ovarian cysts for me. My mother got her second pfizer vaccine and passed away shortly after.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Survey response — 3 months, dose 1
MedDRA: Ear infection, Ovarian cyst, Tooth fracture — Feeling: Poor · 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

Free text: Ear infection, ovarian cysts, shifted then broken molar.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Report sent to call center — 3 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-07
Call 1 — Could Not Reach Participant
2021-07-12
Call 2 — Could Not Reach Participant
2021-07-17
Call 3 — Left Voicemail
2022-04-02
Survey response — 12 months, dose 1
MedDRA: Ear infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Ear infections

MedDRA releases: 2024-11 · check-in free text available
2022-04-02
Report sent to call center — 12 months, dose 1
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-04
Call 1 — Requested Callback
2022-04-04
Callback requested for
06:00PM ET
2022-04-04
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-07-02	Successful	Participant prefers to complete VAERS report online
2022-04-02	Successful 2022-04-04	Participant prefers to complete VAERS report online

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-03

Systemic reaction (other): Soreness/pain seems to have spread to approx 2 inch diameter around injection site

2021-04-04

Systemic reaction (other): Just the muscles around injection site.

Release 7 — days 1–6 daily, dose 1

2021-04-06

Systemic reaction (other): Possibly seasonal allergy related sore throat & general tiredness

2021-04-08

Systemic reaction (other): Felt feverish overnight. Better now. Could be psychosomatic. My mother died tuesday.

Release 7 — day 7, dose 1

2021-04-11

Systemic reaction (other): Higher blood pressure & fatigue. Might be related to other things. Preparing to bury my mother.

Release 7 — day 21, dose 1

2021-04-24

Symptoms: Possible miscarriage; Ovarian cysts, & abnormal vaginal bleeding.

Release 8 — day 42, dose 1

2021-05-16

Symptoms: Miscarriage & Ovarian cysts for me. My mother got her second pfizer vaccine and passed away shortly after.

Release 9 — 3 months, dose 1

2021-07-02

Symptoms: Ear infection, ovarian cysts, shifted then broken molar.

Release 11 — 12 months, dose 1

2022-04-02

Symptoms: Ear infections

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	Ear infection	✓	✓	✓
SD	Ovarian cyst	✓	✓	✓
SD	Tooth fracture	✓	✓	✓
SD	Unevaluable event	✓	✓	✓
SD	Vaginal haemorrhage	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site reaction	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pre-existing disease	○	✓	○
SRO	Pyrexia	✓	✓	✓
SRO	Somatic symptom disorder	○	✓	○

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