R8H-10197-46447

4 vaccinations 12 coded responses 32 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 069 / CT
Registered: 2021-03-08

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

Registered dependents

H6R-30227-34045 Child or adolescent in my care · Male · 2022-07-13

Timeline

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

2021-03-05
Dose 1 — Moderna
2021-03-08
Registered in v-safe
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Headache · Be unable to do your normal daily activities

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

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

Adult check-in
2021-03-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 1
Feeling: Poor

Adult check-in
2021-04-02
Dose 2 — Moderna
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Nausea, Diarrhea · Be unable to work or attend school

Adult check-in
2021-04-09
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-23
Survey response — day 21, dose 2
MedDRA: Migraine — Feeling: Good · Be unable to do your normal daily activities

Free text: Migraine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-03
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-11
Dose 3 — Moderna
2022-04-02
Survey response — 12 months, dose 2
MedDRA: Pregnancy, Stillbirth — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Pregnancy and stillbirth

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Survey response — 6 months, dose 3
MedDRA: Ageusia, Anosmia, Cough, Foetal disorder, Nasal congestion, Pyrexia, Stillbirth — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Loss of smell and taste. Fever. Cough. Stuffy nose. Pregnancy loss/stillbirth at 23 weeks due to nuchal chord

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
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

Hospitalization · 1 call case(s)
2022-05-13
Call 2 — Left Voicemail
2022-09-30
Dose 4 — Moderna
2022-10-05
Survey response — days 1–6 daily, dose 4
MedDRA: Pregnancy — Feeling: Good · Nausea, Vomiting

Free text: Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-10-06
Survey response — days 1–6 daily, dose 4
MedDRA: Pregnancy — Feeling: Good · Fatigue or tiredness

Free text: Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Survey response — day 7, dose 4
MedDRA: Constipation, Pregnancy — Feeling: Good · Fatigue or tiredness, Abdominal pain

Free text: Constipation, pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-10-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-21
Survey response — day 21, dose 4
MedDRA: Oropharyngeal pain — Feeling: Fair

Free text: Soar throat

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Survey response — day 28, dose 4
MedDRA: Oropharyngeal pain — Feeling: Fair

Free text: Soar throat

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Survey response — day 35, dose 4
MedDRA: Nasopharyngitis — Feeling: Fair

Free text: Cold symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-11-11
Survey response — day 42, dose 4
MedDRA: Cough, Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Cough, aches

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Survey response — 3 months, dose 4
MedDRA: Cough, Joint dislocation — Feeling: Fair · 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, Hospitalization

Free text: Unrelenting cough, dislocated ribs from coughing

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
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

Outpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
2023-01-04
Call 1 — Left Voicemail
2023-01-04
Call 1 — Left Voicemail
2023-01-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-01-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-31
Survey response — 6 months, dose 4
MedDRA: Asthma, Bronchitis — Feeling: Fair · 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, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-03-31
Report sent to call center — 6 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-04-03
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-02	Moderna
3	2021-11-11	Moderna	No
4	2022-09-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-12	Successful 2023-01-04	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-30	Successful 2023-01-04	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-31	Unsuccessful

Free text

Release 7 — day 21, dose 2

2021-04-23

Symptoms: Migraine

Release 11 — 12 months, dose 2

2022-04-02

Symptoms: Pregnancy and stillbirth

Release 11 — 6 months, dose 3

2022-05-12

Symptoms: Loss of smell and taste. Fever. Cough. Stuffy nose. Pregnancy loss/stillbirth at 23 weeks due to nuchal chord

Release 12 — days 1–6 daily, dose 4

2022-10-05

Systemic reaction (other): Pregnancy

2022-10-06

Systemic reaction (other): Pregnancy

Release 12 — day 7, dose 4

2022-10-07

Systemic reaction (other): Constipation, pregnancy

Release 12 — day 21, dose 4

2022-10-21

Symptoms: Soar throat

Release 12 — day 28, dose 4

2022-10-30

Symptoms: Soar throat

Release 12 — day 35, dose 4

2022-11-06

Symptoms: Cold symptoms

Release 12 — day 42, dose 4

2022-11-11

Symptoms: Cough, aches

Release 12 — 3 months, dose 4

2022-12-30

Symptoms: Unrelenting cough, dislocated ribs from coughing

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	Ageusia	·	·	✓
SD	Anosmia	·	·	✓
SD	Asthma	·	·	✓
SD	Bronchitis	·	·	✓
SD	Cough	·	·	✓
SD	Foetal disorder	·	·	✓
SD	Joint dislocation	·	·	✓
SD	Migraine	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pregnancy	·	·	✓
SD	Pyrexia	·	·	✓
SD	Stillbirth	·	·	✓
SRO	Constipation	·	·	✓
SRO	Pregnancy	·	·	✓

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