LXA-25092-56558

3 vaccinations 6 coded responses 29 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 500 / IA
Registered: 2021-02-05

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

Registered dependents

TK6-12146-91083 Child or adolescent in my care · Male · 2022-06-25

Timeline

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

2021-01-08
Dose 1 — Moderna
2021-02-05
Registered in v-safe
2021-02-05
Dose 2 — Moderna
2021-02-05
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain

Free text: Light-headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-05
Survey response — day 28, dose 2
MedDRA: Abdominal pain upper, Vomiting — Feeling: Fair · Be unable to work

Free text: Upper central and left abdominal pain with vomiting

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-19
Survey response — day 42, dose 2
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-06
Survey response — 6 months, dose 2
MedDRA: Anxiety, Depression — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Depression with anxiety

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-16
Call 1 — Left Voicemail
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-28
Survey response — 3 months, dose 3
MedDRA: Cough, Oropharyngeal pain — Feeling: Good

Free text: Sore throat, cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Biochemical pregnancy — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Chemical Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-05	Moderna
3	2021-10-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-06	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-29	Successful 2022-05-02	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — day 0, dose 2

2021-02-05

Systemic reaction (other): Light-headed

Release 5 — day 28, dose 2

2021-03-05

Symptoms: Upper central and left abdominal pain with vomiting

Release 5 — day 42, dose 2

2021-03-19

Symptoms: Sore throat

Release 9 — 6 months, dose 2

2021-08-06

Symptoms: Depression with anxiety

Release 11 — 3 months, dose 3

2022-01-28

Symptoms: Sore throat, cough

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Chemical Pregnancy

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	Abdominal pain upper	✓	✓	✓
SD	Anxiety	✓	·	✓
SD	Biochemical pregnancy	·	·	✓
SD	Cough	·	·	✓
SD	Depression	✓	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Dizziness	✓	✓	✓

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