UHA-13817-13364
4 vaccinations
7 coded responses
54 check-ins
7 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 537 / WI
- Registered
- 2021-02-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
8FW-67843-64419
Child or adolescent in my care · Female · 2022-07-05
Timeline
-
2021-02-13
Registered in v-safe
-
2021-02-13
Dose 1 — Moderna
-
2021-02-13
Health check-in — day 0, dose 1Feeling: Fair · Site: Pain · Fatigue or tiredness, NauseaAdult check-in
-
2021-02-14
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tiredness, NauseaAdult check-in
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-27
- 2021-03-06
- 2021-03-13
-
2021-03-14
Dose 2 — Moderna
- 2021-03-14
-
2021-03-15
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesFree text: FaintnessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-16
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-28
- 2021-04-04
- 2021-04-11
- 2021-04-19
- 2021-04-25
- 2021-06-13
- 2021-09-12
-
2021-11-12
Dose 3 — Moderna
-
2021-11-13
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-14
- 2021-11-15
- 2021-11-16
- 2021-11-17
-
2021-11-18
Health check-in — days 1–6 daily, dose 3Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-11-19
- 2021-11-26
- 2021-12-03
-
2021-12-10
Survey response — day 28, dose 3MedDRA: Chills, Decreased appetite, Fatigue, Headache, Pain — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Chills, aches, fatigue, headache, loss of appetiteMedDRA releases: 2024-11 · check-in free text available
-
2021-12-17
Survey response — day 35, dose 3MedDRA: Pregnancy — Feeling: GoodFree text: PregnancyMedDRA releases: 2024-11 · check-in free text available
- 2021-12-24
-
2022-02-13
Survey response — 3 months, dose 3MedDRA: Abortion spontaneous, Surgery — 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 professionalFree text: Symptoms: Miscarriage · Healthcare visit (other): Outpatient surgeryMedDRA releases: 2024-11 · check-in free text available
-
2022-02-13
Report sent to call center — 3 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2022-02-21
-
2022-02-23
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-05-14
-
2022-09-17
Dose 4 — ModernaCo-administered: Flu
-
2022-09-17
Health check-in — day 0, dose 4Feeling: Fair · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
-
2022-09-18
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
- 2022-09-19
- 2022-09-21
- 2022-09-22
- 2022-09-23
-
2022-09-24
Survey response — day 7, dose 4MedDRA: Pregnancy — Feeling: Good · Fatigue or tiredness, NauseaFree text: PregnantMedDRA releases: 2024-11 · check-in free text available
- 2022-10-01
- 2022-10-08
- 2022-10-15
-
2022-10-22
Survey response — day 35, dose 4MedDRA: Fatigue, Headache, Oropharyngeal pain — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Fatigue, headache, sore throatMedDRA releases: 2024-11 · check-in free text available
-
2022-10-29
Survey response — day 42, dose 4MedDRA: Cough, Fatigue, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Dry Cough, congestion, fatigue-- tested megative for covid 3xMedDRA releases: 2024-11 · check-in free text available
- 2022-12-17
- 2023-03-18
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-13 | Moderna | |
| 2 | 2021-03-14 | Moderna | |
| 3 | 2021-11-12 | Moderna | No |
| 4 | 2022-09-17 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-13 | Successful 2022-02-23 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Faintness
Release 10 — day 28, dose 3
Symptoms: Chills, aches, fatigue, headache, loss of appetite
Release 10 — day 35, dose 3
Symptoms: Pregnancy
Release 11 — 3 months, dose 3
Release 12 — day 7, dose 4
Systemic reaction (other): Pregnant
Release 12 — day 35, dose 4
Symptoms: Fatigue, headache, sore throat
Release 12 — day 42, dose 4
Symptoms: Dry Cough, congestion, fatigue-- tested megative for covid 3x
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 | Surgery | · | · | ✓ |
| SD | Abortion spontaneous | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Decreased appetite | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pregnancy | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Pregnancy | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release