VJ7-10779-50871

4 vaccinations 15 coded responses 46 check-ins 15 free-text entries 2 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 980 / WA
Registered: 2021-04-02

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

2021-04-02
Registered in v-safe
2021-04-02
Dose 1 — Moderna
2021-04-02
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Injection site pain, Migraine, Myalgia, New daily persistent headache — Feeling: Good · Site: Pain · Headache, Muscle or body aches

Free text: Full disclosure: muscles most likely sore from physical therapy and working in the yard. Headaches and migraines were happening prior to vaccine (daily for the past week). Don't think current symptoms were related to vaccine except pain at injection site.

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

Adult check-in
2021-04-05
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Headache

Free text: Headache/migraine at high frequency preexisting before vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 7, dose 1
Feeling: Good · Chills

Adult check-in
2021-04-16
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site swelling, Rhinorrhoea — Feeling: Good

Free text: Runny nose. Could be allergies. Noticed after previous check in that my injection site was red and a little swollen. That was a week after I had it. Immediate days following injection there was barely any redness and no swelling. Delayed reaction!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-30
Dose 2 — Moderna
2021-04-30
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-05-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Sneezing — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Coughing, sneezing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Cough, Pre-existing disease, Sneezing, Urticaria — Feeling: Good · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Coughing, sneezing, asthma flaring up, urticaria flaring up bad

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Pre-existing disease, Urticaria — Feeling: Good · Fever · Headache, Nausea

Free text: Coughing, urticaria flaring up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Urticaria — Feeling: Good · Headache

Free text: Urticaria flaring up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Urticaria — Feeling: Good

Free text: Urticaria flaring up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — day 7, dose 2
Feeling: Good · None

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

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

Adult check-in
2021-05-28
Survey response — day 28, dose 2
MedDRA: Chills, Cough, Dry throat, Fatigue, Headache, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Got a cold: Temperature up to 100.1F. Sore, dry throat. Coughing. Difficulty speaking. Headache. Fatigue. Runny nose. Chills. Negative covid test.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-01
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-08
Dose 3 — Moderna
2021-10-30
Survey response — day 21, dose 3
MedDRA: Cough, Fatigue, Feeling of body temperature change, Myalgia, Oropharyngeal pain, Pyrexia, Reaction to previous exposure to any vaccine — Feeling: Good · Be unable to do your normal daily activities

Free text: Strong reaction to booster dose. Worse than second dose. Fever, fatigue, achy muscles, feeling extremes of hot and cold at same time, coughing, mild sore throat. Symptoms subsided by 48 hr mark.

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-07
Survey response — 3 months, dose 3
MedDRA: Pre-existing disease, Unevaluable event, Urticaria — Feeling: Fair · 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: Symptoms: Urticaria flare up. Likely related to lapse in medicine scheduling for pre-existing condition - unrelated to vaccine. · Healthcare visit (other): Prednisone prescription

MedDRA releases: 2024-11 · check-in free text available
2022-01-07
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-10
Call 1 — Left Voicemail
2022-01-20
Call 2 — Left Voicemail
2022-01-20
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-08
Survey response — 12 months, dose 3
MedDRA: Brain fog, COVID-19, Cough, Fatigue, Oropharyngeal pain, Pharyngeal inflammation — 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

Free text: Got covid twice. Once in spring 2022, once in fall 2022. First was mild symptoms. Second was severe and resulted in intense long covid symptoms - sore, inflamed throat, coughing, off and on brain fog, mild fatigue, requiring high dose steroids.

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Report sent to call center — 12 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)
2022-10-10
Call 1 — Left Voicemail
2022-10-12
Callback requested for
03:00PM ET
2022-10-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-03
Dose 4 — Pfizer-BioNTech
2022-12-03
Survey response — day 0, dose 4
MedDRA: Pruritus — Feeling: Fair · Site: Pain, Redness, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Free text: Temporary itchiness all over body

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
Survey response — days 1–6 daily, dose 4
MedDRA: Brain fog, Dizziness — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Dizzy, severe brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-12-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2022-12-06
Survey response — days 1–6 daily, dose 4
MedDRA: Insomnia — Feeling: Good · Headache, Fatigue or tiredness

Free text: Insomnia

MedDRA releases: 2024-11 · check-in free text available
2022-12-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache

Adult check-in
2022-12-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache

Adult check-in
2022-12-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache

Adult check-in
2022-12-10
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-12-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-12-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-12-31
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2023-01-07
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-01-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-03-04
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-06-03
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Moderna
2	2021-04-30	Moderna
3	2021-10-08	Moderna	No
4	2022-12-03	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-07	Successful 2022-01-20	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-08	Successful 2022-10-12	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-03

Systemic reaction (other): Full disclosure: muscles most likely sore from physical therapy and working in the yard. Headaches and migraines were happening prior to vaccine (daily for the past week). Don't think current symptoms were related to vaccine except pain at injection site.

2021-04-05

Systemic reaction (other): Headache/migraine at high frequency preexisting before vaccine

Release 7 — day 14, dose 1

2021-04-16

Symptoms: Runny nose. Could be allergies. Noticed after previous check in that my injection site was red and a little swollen. That was a week after I had it. Immediate days following injection there was barely any redness and no swelling. Delayed reaction!

Release 8 — days 1–6 daily, dose 2

2021-05-02

Systemic reaction (other): Coughing, sneezing

2021-05-03

Systemic reaction (other): Coughing, sneezing, asthma flaring up, urticaria flaring up bad

2021-05-04

Systemic reaction (other): Coughing, urticaria flaring up

2021-05-05

Systemic reaction (other): Urticaria flaring up

2021-05-06

Systemic reaction (other): Urticaria flaring up

Release 8 — day 28, dose 2

2021-05-28

Symptoms: Got a cold: Temperature up to 100.1F. Sore, dry throat. Coughing. Difficulty speaking. Headache. Fatigue. Runny nose. Chills. Negative covid test.

Release 10 — day 21, dose 3

2021-10-30

Symptoms: Strong reaction to booster dose. Worse than second dose. Fever, fatigue, achy muscles, feeling extremes of hot and cold at same time, coughing, mild sore throat. Symptoms subsided by 48 hr mark.

Release 10 — 3 months, dose 3

2022-01-07

Symptoms: Urticaria flare up. Likely related to lapse in medicine scheduling for pre-existing condition - unrelated to vaccine.

Healthcare visit (other): Prednisone prescription

Release 12 — 12 months, dose 3

2022-10-08

Symptoms: Got covid twice. Once in spring 2022, once in fall 2022. First was mild symptoms. Second was severe and resulted in intense long covid symptoms - sore, inflamed throat, coughing, off and on brain fog, mild fatigue, requiring high dose steroids.

Release 12 — day 0, dose 4

2022-12-03

Systemic reaction (other): Temporary itchiness all over body

Release 12 — days 1–6 daily, dose 4

2022-12-04

Systemic reaction (other): Dizzy, severe brain fog

2022-12-06

Systemic reaction (other): Insomnia

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	Unevaluable event	·	·	✓
SD	Brain fog	·	·	✓
SD	Chills	✓	✓	✓
SD	Cough	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Dry throat	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling of body temperature change	·	·	✓
SD	Headache	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pharyngeal inflammation	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Reaction to previous exposure to any vaccine	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Urticaria	·	·	✓
SRO	Asthma	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Insomnia	·	·	✓
SRO	Migraine	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	New daily persistent headache	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	·	·	✓
SRO	Sneezing	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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