QHX-32840-96294

5 vaccinations 12 coded responses 64 check-ins 12 free-text entries 1 call case

Sex: Female
Age at first dose: 31-35
ZIP prefix: 481 / MI
Registered: 2021-03-28

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

Registered dependents

Y4P-28496-17645 Child or adolescent in my care · Female · 2021-11-05

5FW-26880-80223 Child or adolescent in my care · Male · 2022-03-03

Timeline

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

2021-03-27
Dose 1 — Moderna
2021-03-28
Registered in v-safe
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-03
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-10
Survey response — day 14, dose 1
MedDRA: Nasopharyngitis — Feeling: Fair

Free text: Mild cold from child.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-24
Dose 2 — Moderna
2021-04-24
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Dizziness — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Dizziness, lack of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-30
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia — Feeling: Fair

Free text: Ongoing heartburn since Saturday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-29
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-05
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-24
Survey response — 3 months, dose 2
MedDRA: Upper respiratory tract infection — Feeling: Good · Be unable to do your normal daily activities

Free text: Upper respiratory infection

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-04
Dose 3 — Moderna
2021-11-05
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 · Be unable to do your normal daily activities

Adult check-in
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain

Free text: Swollen lymph node in armpit

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Swollen lymph node

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-11
Survey response — day 7, dose 3
MedDRA: Palpitations — Feeling: Fair · Headache

Free text: Heart palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-16
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-03
Health check-in — 3 months, dose 3
Feeling: Good

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

Adult check-in
2022-07-22
Dose 4 — Pfizer-BioNTech
2022-07-22
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-23
Survey response — days 1–6 daily, dose 4
MedDRA: Dyspepsia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Heartburn

MedDRA releases: 2024-11 · check-in free text available
2022-07-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-07-25
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-07-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-07-27
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-07-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-07-29
Health check-in — day 7, dose 4
Feeling: Good · Headache

Adult check-in
2022-08-05
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-12
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-19
Survey response — day 28, dose 4
MedDRA: Discomfort, Headache, Malaise, Oropharyngeal pain — Feeling: Poor

Free text: Feeling unwell - sore throat, headache, nasal pressure

MedDRA releases: 2024-11 · check-in free text available
2022-08-26
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-09-02
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-10-21
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-04
Dose 5 — Moderna
2022-11-04
Health check-in — day 0, dose 5
Feeling: Fair · Site: Pain · Headache

Adult check-in
2022-11-05
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-11-06
Survey response — days 1–6 daily, dose 5
MedDRA: Dizziness, Dyspepsia, Hyperhidrosis — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sweating, heartburn, light headedness

MedDRA releases: 2024-11 · check-in free text available
2022-11-07
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache

Adult check-in
2022-11-08
Survey response — days 1–6 daily, dose 5
MedDRA: Ocular vascular disorder — Feeling: Poor · Headache · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I've been diagnosed with an vascular eye problem related directly to this vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-11-08
Report sent to call center — days 1–6 daily, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-09
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Headache, Fatigue or tiredness

Adult check-in
2022-11-09
Call successful
Participant prefers to complete VAERS report online
2022-11-10
Survey response — days 1–6 daily, dose 5
MedDRA: Illness — Feeling: Poor · Headache, Fatigue or tiredness

Free text: Have a non Covid illness

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-25
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-12-02
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-12-09
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2023-02-03
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-05-06
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-27	Moderna
2	2021-04-24	Moderna
3	2021-11-04	Moderna	No
4	2022-07-22	Pfizer-BioNTech	No
5	2022-11-04	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 7 — day 14, dose 1

2021-04-10

Symptoms: Mild cold from child.

Release 7 — days 1–6 daily, dose 2

2021-04-25

Systemic reaction (other): Dizziness, lack of appetite

Release 8 — days 1–6 daily, dose 2

2021-04-30

Systemic reaction (other): Ongoing heartburn since Saturday

Release 9 — 3 months, dose 2

2021-07-24

Symptoms: Upper respiratory infection

Release 10 — days 1–6 daily, dose 3

2021-11-06

Systemic reaction (other): Swollen lymph node in armpit

2021-11-07

Systemic reaction (other): Swollen lymph node

Release 10 — day 7, dose 3

2021-11-11

Systemic reaction (other): Heart palpitations

Release 12 — days 1–6 daily, dose 4

2022-07-23

Systemic reaction (other): Heartburn

Release 12 — day 28, dose 4

2022-08-19

Symptoms: Feeling unwell - sore throat, headache, nasal pressure

Release 12 — days 1–6 daily, dose 5

2022-11-06

Systemic reaction (other): Sweating, heartburn, light headedness

2022-11-08

Systemic reaction (other): I've been diagnosed with an vascular eye problem related directly to this vaccine.

2022-11-10

Systemic reaction (other): Have a non Covid illness

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	Discomfort	·	·	✓
SD	Headache	·	·	✓
SD	Malaise	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Upper respiratory tract infection	✓	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspepsia	✓	✓	✓
SRO	Hyperhidrosis	·	·	✓
SRO	Illness	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Ocular vascular disorder	·	·	✓
SRO	Palpitations	·	·	✓

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