L9W-15694-25391

3 vaccinations 11 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 921 / CA
Registered: 2021-01-18

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

2021-01-15
Dose 1 — Moderna
2021-01-18
Registered in v-safe
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspepsia — Feeling: Good · Site: Pain · Headache

Free text: Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
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: Dyspepsia — Feeling: Good

Free text: Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Survey response — day 28, dose 1
MedDRA: Dyspepsia — Feeling: Good

Free text: Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Dose 2 — Moderna
2021-02-14
Survey response — day 0, dose 2
MedDRA: Amnesia, Dyspepsia — Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Memory loss & severe heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia — Feeling: Good · Headache, Fatigue or tiredness

Free text: Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia — Feeling: Good · Fatigue or tiredness

Free text: Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-23
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-28
Survey response — day 14, dose 2
MedDRA: Amnesia — Feeling: Good

Free text: Memory loss

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — day 21, dose 2
MedDRA: Fatigue, Feeling abnormal, Memory impairment, Ovulation delayed — Feeling: Fair

Free text: -Memory problem. I have such a hard time remembering things. I feel like my brain is foggy all the time-Loss of ovulation; I have been ovulating prior to getting this vaccine, but I haven't ovulated ever since -Extreme fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — day 28, dose 2
MedDRA: Dyspepsia, Memory impairment — Feeling: Good

Free text: Memory problem Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — day 35, dose 2
MedDRA: Memory impairment — Feeling: Good

Free text: Memory problem

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-15
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-06
Dose 3 — Pfizer-BioNTech
2022-02-14
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-05-09
Survey response — 6 months, dose 3
MedDRA: Abortion spontaneous — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I had 3 miscarriages since Oct 2021

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-05-10
Call successful
Participant prefers to complete VAERS report online
2022-11-06
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-14	Moderna
3	2021-11-06	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-09	Successful 2022-05-10	Participant prefers to complete VAERS report online

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-18

Systemic reaction (other): Heartburn

Release 3 — day 14, dose 1

2021-01-29

Symptoms: Heartburn

Release 4 — day 28, dose 1

2021-02-12

Symptoms: Heartburn

Release 4 — day 0, dose 2

2021-02-14

Systemic reaction (other): Memory loss & severe heartburn

Release 4 — days 1–6 daily, dose 2

2021-02-18

Systemic reaction (other): Heartburn

2021-02-19

Systemic reaction (other): Heartburn

Release 4 — day 14, dose 2

2021-02-28

Symptoms: Memory loss

Release 5 — day 21, dose 2

2021-03-08

Symptoms: -Memory problem. I have such a hard time remembering things. I feel like my brain is foggy all the time-Loss of ovulation; I have been ovulating prior to getting this vaccine, but I haven't ovulated ever since -Extreme fatigue

Release 5 — day 28, dose 2

2021-03-14

Symptoms: Memory problem Heartburn

Release 6 — day 35, dose 2

2021-03-21

Symptoms: Memory problem

Release 11 — 6 months, dose 3

2022-05-09

Symptoms: I had 3 miscarriages since Oct 2021

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	Amnesia	✓	✓	✓
SD	Dyspepsia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Memory impairment	✓	✓	✓
SD	Ovulation delayed	✓	✓	✓
SRO	Amnesia	✓	✓	✓
SRO	Dyspepsia	✓	✓	✓

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