Q5R-43943-82089

4 vaccinations 15 coded responses 34 check-ins 14 free-text entries 4 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 074 / NJ
Registered: 2021-02-13

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

Registered dependents

TFX-30087-03065 Child or adolescent in my care · Male · 2022-09-23

Timeline

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

2021-02-13
Registered in v-safe
2021-02-13
Dose 1 — Moderna
2021-02-13
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Taste disorder, Throat irritation — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Extremely tired and unable to get out of bed. Went to bed at 10 pm; tried getting up at 10 am but fell back asleep until 12 pm. Noticed a change in my ability to taste too. Throat also feels irritated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Lacrimation increased, Ocular hyperaemia — Feeling: Poor · Site: Pain, Swelling · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Eyes slightly blood shot and tearing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Condition aggravated, Hypoaesthesia, Neurological symptom, Paraesthesia — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Last night experienced an exacerbation of neurological symptoms in right foot/ lower leg: numbness, & tingling. It subsided after 30 to 45 min. This afternoon similar experience in left foot but not as intense and subsided quickly

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Headache · Be unable to do your normal daily activities

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Migraine — Feeling: Fair · Headache · Be unable to do your normal daily activities

Free text: Significant migraine carried over from yesterday into early afternoon

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-27
Survey response — day 14, dose 1
MedDRA: Hypoaesthesia, Insomnia, Migraine, Paraesthesia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Numbness tingling in left leg, difficulty sleeping, & minor migraine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — day 21, dose 1
MedDRA: Migraine — Feeling: Good · Be unable to do your normal daily activities

Free text: Migraine Friday into Saturday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Dose 2 — Moderna
2021-03-13
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-14
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, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-20
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-03
Survey response — day 21, dose 2
MedDRA: Fatigue, Myalgia — Feeling: Good · Be unable to do your normal daily activities

Free text: Muscle aches & fatigue 1 day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-17
Survey response — day 35, dose 2
MedDRA: Insomnia — Feeling: Good

Free text: 1 night insomnia. Not normal for me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Survey response — day 42, dose 2
MedDRA: COVID-19, Localised infection, Osteitis, Tooth extraction — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rx to antibiotic given for Infection in jaw & removal of tooth. Not related to vx. Worsened due to COVID 19 & not having it looked at until fully vaxd

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Survey response — 3 months, dose 2
MedDRA: Bone graft, Fatigue, Oral pain, Tooth disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Bone graph in mouth not directly related to COVID. Put off getting problem tooth looked at because of COVID. Pain in mouth, and fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-09
Dose 3 — Moderna
2022-03-13
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-09-14
Dose 4 — Moderna
2022-09-23
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-01
Survey response — day 14, dose 4
MedDRA: Dysmenorrhoea, Eye haemorrhage, Heavy menstrual bleeding, Ophthalmic vein thrombosis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Time of the month. Heavy bleeding, cramps. Pls note: I did not mention before... 4 days after shot I experience a blood clot/ burst blood vessel in left eye.

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-03
Call 2 — Left Voicemail
2022-10-07
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-12
Survey response — day 28, dose 4
MedDRA: Smear cervix abnormal, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Irregular pap smear · Healthcare visit (other): Appt scheduled

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-13
Call 3 — Left Voicemail
2022-10-13
Call 2 — Left Voicemail
2022-10-21
Survey response — day 35, dose 4
MedDRA: Nodule, Ultrasound scan abnormal, Unevaluable event, Uterine polyp — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: 10/19/2022 Ultrasound - pelvis: echogenic nodule measuring up to 1.3 cm suspicious for endometrial polyp · Healthcare visit (other): Appointment scheduled

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-24
Call 3 — Left Voicemail
2022-10-24
Call 2 — Left Voicemail
2022-10-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-10-28
Call X — Could Not Reach Participant
2022-10-28
Call X — Left Voicemail
2022-10-28
Call 3 — Could Not Reach Participant
2022-12-14
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-19
Survey response — 6 months, dose 4
MedDRA: Blood pressure fluctuation, Botulinum toxin injection, Haematidrosis, Migraine, Office visit, Polypectomy, Pre-existing disease, Surgery, Uterine dilation and curettage — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-03-19
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2023-03-20
Call 1 — Left Voicemail
2023-03-20
Call 1 — Left Voicemail
2023-03-20
Call 1 — Left Voicemail
2023-03-20
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-13	Moderna
3	2021-11-09	Moderna	No
4	2022-09-14	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-10-01	Unsuccessful
2022-10-12	Unsuccessful
2022-10-21	Unsuccessful
2023-03-19	Unsuccessful

Free text

Release 4 — day 0, dose 1

2021-02-13

Systemic reaction (other): Light headed

Release 4 — days 1–6 daily, dose 1

2021-02-14

Systemic reaction (other): Extremely tired and unable to get out of bed. Went to bed at 10 pm; tried getting up at 10 am but fell back asleep until 12 pm. Noticed a change in my ability to taste too. Throat also feels irritated

2021-02-15

Systemic reaction (other): Eyes slightly blood shot and tearing

2021-02-16

Systemic reaction (other): Last night experienced an exacerbation of neurological symptoms in right foot/ lower leg: numbness, & tingling. It subsided after 30 to 45 min. This afternoon similar experience in left foot but not as intense and subsided quickly

2021-02-19

Systemic reaction (other): Significant migraine carried over from yesterday into early afternoon

Release 4 — day 14, dose 1

2021-02-27

Symptoms: Numbness tingling in left leg, difficulty sleeping, & minor migraine

Release 5 — day 21, dose 1

2021-03-06

Symptoms: Migraine Friday into Saturday

Release 6 — day 21, dose 2

2021-04-03

Symptoms: Muscle aches & fatigue 1 day

Release 7 — day 35, dose 2

2021-04-17

Symptoms: 1 night insomnia. Not normal for me.

Release 7 — day 42, dose 2

2021-04-24

Symptoms: Rx to antibiotic given for Infection in jaw & removal of tooth. Not related to vx. Worsened due to COVID 19 & not having it looked at until fully vaxd

Release 9 — 3 months, dose 2

2021-06-12

Symptoms: Bone graph in mouth not directly related to COVID. Put off getting problem tooth looked at because of COVID. Pain in mouth, and fatigue.

Release 12 — day 14, dose 4

2022-10-01

Symptoms: Time of the month. Heavy bleeding, cramps. Pls note: I did not mention before... 4 days after shot I experience a blood clot/ burst blood vessel in left eye.

Release 12 — day 28, dose 4

2022-10-12

Symptoms: Irregular pap smear

Healthcare visit (other): Appt scheduled

Release 12 — day 35, dose 4

2022-10-21

Symptoms: 10/19/2022 Ultrasound - pelvis: echogenic nodule measuring up to 1.3 cm suspicious for endometrial polyp

Healthcare visit (other): Appointment scheduled

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	Haematidrosis	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Surgery	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Blood pressure fluctuation	·	·	✓
SD	Bone graft	✓	✓	✓
SD	Botulinum toxin injection	·	·	✓
SD	COVID-19	✓	✓	✓
SD	Dysmenorrhoea	·	·	✓
SD	Eye haemorrhage	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Haematidrosis	·	·	✓
SD	Heavy menstrual bleeding	·	·	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Localised infection	·	·	✓
SD	Migraine	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Nodule	·	·	✓
SD	Ophthalmic vein thrombosis	·	·	✓
SD	Oral pain	✓	✓	✓
SD	Osteitis	✓	✓	○
SD	Paraesthesia	✓	✓	✓
SD	Polypectomy	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Smear cervix abnormal	·	·	✓
SD	Tooth disorder	✓	✓	✓
SD	Tooth extraction	·	·	✓
SD	Ultrasound scan abnormal	·	·	✓
SD	Uterine dilation and curettage	·	·	✓
SD	Uterine polyp	·	·	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Lacrimation increased	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Neurological symptom	✓	✓	✓
SRO	Ocular hyperaemia	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Taste disorder	✓	✓	✓
SRO	Throat irritation	✓	✓	✓

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