QPV-42953-87009

3 vaccinations 5 coded responses 37 check-ins 5 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 672 / KS
Registered: 2021-02-28

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

2021-02-28
Registered in v-safe
2021-02-28
Dose 1 — Moderna
2021-02-28
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Fast heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

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

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-07
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-14
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-21
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-28
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-31
Dose 2 — Moderna
2021-04-01
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, Abdominal pain · Be unable to work

Adult check-in
2021-04-02
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, Diarrhea · Be unable to do your normal daily activities

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

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

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-08
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-01
Survey response — 6 months, dose 2
MedDRA: Nasopharyngitis — Feeling: Good

Free text: Cold like symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Dose 3 — Moderna
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-06
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain, Redness, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-15
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-20
Survey response — day 21, dose 3
MedDRA: Back pain, Cough — Feeling: Poor

Free text: Sore throat and cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — day 28, dose 3
MedDRA: Ear pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Ear ache

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-11
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-02
Survey response — 6 months, dose 3
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 · Outpatient clinic or urgent care clinic visit

Free text: Miscarriage

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Report sent to call center — 6 months, dose 3
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)
2022-05-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-01
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-28	Moderna
2	2021-03-31	Moderna
3	2021-10-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-02	Successful 2022-05-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 4 — days 1–6 daily, dose 1

2021-03-01

Systemic reaction (other): Fast heart rate

Release 9 — 6 months, dose 2

2021-10-01

Symptoms: Cold like symptoms

Release 10 — day 21, dose 3

2021-11-20

Symptoms: Sore throat and cough

Release 10 — day 28, dose 3

2021-11-27

Symptoms: Ear ache

Release 11 — 6 months, dose 3

2022-05-02

Symptoms: Miscarriage

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	Back pain	·	·	✓
SD	Cough	·	·	✓
SD	Ear pain	·	·	✓
SD	Nasopharyngitis	·	·	✓
SRO	Heart rate increased	✓	✓	✓

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