P4X-21761-39390

4 vaccinations 6 coded responses 52 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 786 / TX
Registered: 2021-08-04

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

Registered dependents

CMF-33396-39974 Child or adolescent in my care · Male · 2022-06-22

Timeline

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

2021-08-04
Registered in v-safe
2021-08-04
Dose 1 — Moderna
2021-08-04
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-08-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-08-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-08-18
Survey response — day 14, dose 1
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 · Telehealth, virtual health, or email health consultation

Free text: I had a miscarriage on 8/16/2021.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-18
Report sent to call center — day 14, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-09-01
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-09-03
Dose 2 — Moderna
2021-09-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-09-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-09-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-09-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-09-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-09-10
Survey response — day 7, dose 2
MedDRA: Anxiety, Palpitations — Feeling: Good · Headache, Fatigue or tiredness

Free text: Racing Heart but its probably just my anxiety from the pandemic and anti-vax morons

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-09-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-10-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-10-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-10-17
Survey response — day 42, dose 2
MedDRA: Nasopharyngitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I have a mild cold - it is not connected to the vaccine at all

MedDRA releases: 2024-11 · check-in free text available
2021-10-17
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-22
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-05
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-02-04
Dose 3 — Moderna
2022-02-04
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2022-02-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2022-02-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-02-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-02-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-02-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-02-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-02-11
Survey response — day 7, dose 3
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Slightly swollen underarm lymph nodes

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-02-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-03-04
Survey response — day 28, dose 3
MedDRA: Pruritus — Feeling: Good

Free text: My hands and feet itch terribly at night only.

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-03-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-05-06
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-08-05
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-11
Dose 4 — Other-Unknown
2022-11-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-11-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-11-14
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-11-15
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-18
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-25
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-12-02
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-12-09
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-16
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-23
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-02-10
Survey response — 3 months, dose 4
MedDRA: COVID-19 — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-02-10
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-02-13
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-04	Moderna	No
2	2021-09-03	Moderna	No
3	2022-02-04	Moderna	No
4	2022-11-11	Other-Unknown	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-18	Successful 2021-08-21	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-17	Successful 2021-10-22	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2023-02-10	Successful 2023-02-13	Does not wish to fill out VAERS report

Free text

Release 9 — day 14, dose 1

2021-08-18

Symptoms: I had a miscarriage on 8/16/2021.

Release 9 — day 7, dose 2

2021-09-10

Systemic reaction (other): Racing Heart but its probably just my anxiety from the pandemic and anti-vax morons

Release 10 — day 42, dose 2

2021-10-17

Symptoms: I have a mild cold - it is not connected to the vaccine at all

Release 11 — day 7, dose 3

2022-02-11

Systemic reaction (other): Slightly swollen underarm lymph nodes

Release 11 — day 28, dose 3

2022-03-04

Symptoms: My hands and feet itch terribly at night only.

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	COVID-19	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pruritus	·	·	✓
SRO	Anxiety	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Palpitations	·	·	✓

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