STE-14106-93923

5 vaccinations 20 coded responses 42 check-ins 19 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 449 / OH
Registered: 2021-01-20

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

2021-01-19
Dose 1 — Moderna
2021-01-20
Registered in v-safe
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good · Site: Pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Oropharyngeal pain — Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good · Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-26
Health check-in — 7 day, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-02
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-02-09
Survey response — 21 day, dose 1
MedDRA: Dizziness, Vertigo — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-16
Survey response — 28 day, dose 1
MedDRA: Dizziness, Loss of personal independence in daily activities, Vertigo — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-22
Dose 2 — Moderna
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Pruritus — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — 7 day, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-08
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-03-22
Survey response — 28 day, dose 2
MedDRA: Abdominal pain, Asthenia, Biopsy, Depressed mood, Vaginal haemorrhage — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-29
Survey response — 35 day, dose 2
MedDRA: Vaginal haemorrhage — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-05
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-05-26
Survey response — 3 month, dose 2
MedDRA: Blood calcium abnormal, Blood magnesium abnormal, Diarrhoea, Dizziness, Electrolyte imbalance, Fatigue, Muscle spasms, Sleep disorder, Tremor, Vertigo — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-26
Report sent to call center — 3 month, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-23
Survey response — 6 month, dose 2
MedDRA: Asthenia, Brain fog, Depression, Electrolyte imbalance, Fatigue, Gastric ulcer, Gastrointestinal bacterial overgrowth, Office visit, Spinal pain, Supraventricular extrasystoles — 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 · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-23
Report sent to call center — 6 month, dose 2
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)
2021-08-26
Call 1 — Left Voicemail
2021-11-26
Dose 3 — Moderna
2022-02-22
Survey response — 12 month, dose 2
MedDRA: Adverse reaction, Fatigue, Sinusitis fungal, Urinary tract infection — 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

MedDRA releases: 2024-11 · check-in answers available
2022-02-22
Report sent to call center — 12 month, dose 2
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 · 1 call case(s)
2022-02-23
Call successful
Participant prefers to complete VAERS report online
2022-05-04
Dose 4 — Moderna
2022-05-06
Survey response — days 1–6 daily, dose 4
MedDRA: Flatulence — Feeling: Good · Site: Pain · Fever · 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

MedDRA releases: 2024-11 · check-in answers available
2022-05-07
Survey response — days 1–6 daily, dose 4
MedDRA: Flatulence — Feeling: Good · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-05-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-05-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-05-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-11
Health check-in — 7 day, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-05-19
Health check-in — 14 day, dose 4
Feeling: Good

Adult check-in
2022-05-25
Health check-in — 21 day, dose 4
Feeling: Good

Adult check-in
2022-06-03
Survey response — 28 day, dose 4
MedDRA: Fatigue — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-06-09
Survey response — 35 day, dose 4
MedDRA: Fatigue, Mobility decreased, Somnolence — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-06-15
Health check-in — 42 day, dose 4
Feeling: Good

Adult check-in
2022-08-03
Health check-in — 3 month, dose 4
Feeling: Good

Adult check-in
2022-10-03
Dose 5 — Moderna
2022-10-08
Survey response — days 1–6 daily, dose 5
MedDRA: Decreased appetite, Headache, Nausea, Throat irritation — Feeling: Good · Site: Pain · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-10-10
Health check-in — 7 day, dose 5
Feeling: Good · Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-10-18
Survey response — 14 day, dose 5
MedDRA: Injection site pain, Pain, Pain in extremity, Weight bearing difficulty — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-10-24
Survey response — 21 day, dose 5
MedDRA: Injection site pain — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-11-02
Health check-in — 28 day, dose 5
Feeling: Good

Adult check-in
2022-11-07
Health check-in — 35 day, dose 5
Feeling: Good

Adult check-in
2022-11-14
Survey response — 42 day, dose 5
MedDRA: Back pain, Heart rate increased, Impaired driving ability, Pain in extremity, Pain in jaw, Palpitations, Sleep disorder, Unevaluable event — 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

MedDRA releases: 2024-11 · check-in answers available
2022-11-14
Report sent to call center — 42 day, 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

1 call case(s)
2022-11-15
Call 1 — Left Voicemail
2023-01-02
Survey response — 3 month, dose 5
MedDRA: Depression, Fatigue, Heart rate abnormal, Lethargy — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2023-04-03
Health check-in — 6 month, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-22	Moderna
3	2021-11-26	Moderna	No
4	2022-05-04	Moderna	No
5	2022-10-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-26	Successful	Participant prefers to complete VAERS report online
2021-08-23	Successful	Participant prefers to complete VAERS report online
2022-02-22	Successful 2022-02-23	Participant prefers to complete VAERS report online
2022-11-14	Unsuccessful

Free text

Release 2

Systemic reaction (other): Slight dizziness

Systemic reaction (other): Slightly dizzy (day 3), mild sore throat (new)

Systemic reaction (other): Dizzy

Release 3

Symptoms: Vertigo. Dizziness began Jan 23.

Release 4

Symptoms: Dizzy began 1/23/21 & became vertigo 2/7/21. Interferes w/daily life. Comes & goes.

Systemic reaction (other): Cant shake fatigue. Right hand very briefly felt very itchy but did not break out. Lasted less than 30 minutes.

Release 6

Symptoms: Vaginal bleeding. Sporadic. Unpleasant cramping. No fever. NO ENERGY. Unhappy mood. Biopsy by (b)(6) 3/25/21. Energy level goes down daily.

redacted (b)(6)

Symptoms: Vaginal bleeding.

Release 8

Symptoms: Bad leg cramps wake from sleep. Shaking. Electrolyte imbalance. Diarrhea magnesium calcium unbalanced. Fatigued. Working diligently w/dr labs & diet to fix. Maybe 1st shot causing dizziness & vertigo was blessing, ???

Release 9

Symptoms: Ectopic atrial beats, gastric ulcer, spinal pain caused by electrolyte imbalance causing debilitating fatigue noticed 3 days after 1st shot. Brain fog. Mild depression. SIBO again but fructose resolvrd.

Healthcare visit (other): Office visits, heart halter, lots of blood draws + osteopath treatments

Release 11

Symptoms: Booster reaction-4 days. Followed by UTI & 2 wks antibiotics, then fungal sinusitis w/fatigue - 2 wks antibiotics & diflucan. Lasted 11/24/21- 2/06/22.

Healthcare visit (other): RXs called in each time. Fatigue again very limiting.

Systemic reaction (other): Flatulence

Symptoms: I can't shake the shadow of fatigue & cautiously monitor my food intake & electrolytes.

Release 12

Symptoms: Continued fatigue & need to sleep 10 hours, still tired. Unhappy about it not allowing me to do much. Still fix food but has to be simple & quick. I did use vacuum..

Systemic reaction (other): 10/4/22. Scratchy throat followed by nausea-no appetite, then splitting headache until 10/6/22.

Symptoms: The injection site (muscle) is sore when moving, hurts to put weight on arm.

Symptoms: My injection site was very sore for last week. OK now.

Symptoms: Racing heart to dangerously high levels (149 BPM). Pain right jaw, arm, back. No known cause. 8pm to 5am. BRIEFLY 49 BPM. Tried sleep 3x, woke after 2 hrs & BPM were still too high. Hospitals in area not known for cardiac help.

Healthcare visit (other): I couldn't drive & my drs offices were closed. I texted friend. Did nothing to aggravate. Just rest.

Free-text releases are not linked to a specific 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	Fatigue	·	·	✓
HCVO	Impaired driving ability	·	·	✓
HCVO	Office visit	✓	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Abdominal pain	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Asthenia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Biopsy	✓	✓	✓
SD	Blood calcium abnormal	✓	✓	✓
SD	Blood magnesium abnormal	✓	✓	✓
SD	Brain fog	✓	·	✓
SD	Depressed mood	✓	✓	✓
SD	Depression	✓	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Electrolyte imbalance	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastric ulcer	✓	·	✓
SD	Gastrointestinal bacterial overgrowth	✓	·	✓
SD	Heart rate abnormal	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Injection site pain	·	·	✓
SD	Lethargy	·	·	✓
SD	Loss of personal independence in daily activities	✓	✓	✓
SD	Mobility decreased	·	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pain in jaw	·	·	✓
SD	Palpitations	·	·	✓
SD	Sinusitis fungal	·	·	✓
SD	Sleep disorder	✓	✓	✓
SD	Somnolence	·	·	✓
SD	Spinal pain	✓	·	✓
SD	Supraventricular extrasystoles	✓	·	✓
SD	Tremor	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SD	Vaginal haemorrhage	✓	✓	✓
SD	Vertigo	✓	✓	✓
SD	Weight bearing difficulty	·	·	✓
SRO	Decreased appetite	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Flatulence	·	·	✓
SRO	Headache	·	·	✓
SRO	Nausea	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Throat irritation	·	·	✓

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