W3K-27623-00378

2 vaccinations 11 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 103 / NY
Registered: 2021-01-19

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
Registered in v-safe
2021-01-19
Dose 1 — Moderna
2021-01-19
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Nausea

Adult check-in
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Asthma — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Asthma attack

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus congestion — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Heavy and painful sinus congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Rhinorrhoea, Sinus congestion — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Sinus congestion today but runny nose since Wednesday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-26
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Abdominal pain

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

Adult check-in
2021-02-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-16
Survey response — day 28, dose 1
MedDRA: Cystitis, Hysterectomy, Urinary tract infection, Uterine dilation and curettage, Uterine polyp — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Polyp in uterus, dnc and hysteromy, uti or bladder infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Dose 2 — Moderna
2021-02-23
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness

Free text: Asthma attacks started Sunday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work

Free text: Asthma flare ups

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Feeling abnormal, Lethargy, Vision blurred — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: No appetite, seeing blurry sometimes. Lethargic. Like run over by truck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-28
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-14
Survey response — day 21, dose 2
MedDRA: Urinary tract infection — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: I have had a uti for a month now and no medicine is working

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — day 28, dose 2
MedDRA: Bacterial infection, Urinary tract infection — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: I have antiresistant uti bacterial infection. On 4th antibiotic now. About to find out if I have thrush due to it. I have also been within 3ft of a covid positive child, but cdc says 3 ft is ok if less then 10 minutes. I generally don't time myself.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-23
Survey response — 3 months, dose 2
MedDRA: Anxiety, Hypertension, Palpitations — 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

Free text: Racing heart, higher anxiety and blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — 3 months, 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)
2022-02-21
Survey response — 12 months, dose 2
MedDRA: COVID-19 — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Oct 2021 my son and I had covid. We didn't receive any trace and track phone calls.

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-21	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-23	Successful 2022-05-13	Not applicable - Accidental Reporting

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): Asthma attack

2021-01-23

Systemic reaction (other): Heavy and painful sinus congestion

2021-01-24

Systemic reaction (other): Sinus congestion today but runny nose since Wednesday.

Release 4 — day 28, dose 1

2021-02-16

Symptoms: Polyp in uterus, dnc and hysteromy, uti or bladder infection.

Release 4 — days 1–6 daily, dose 2

2021-02-23

Systemic reaction (other): Asthma attacks started Sunday

2021-02-24

Systemic reaction (other): Asthma flare ups

2021-02-25

Systemic reaction (other): No appetite, seeing blurry sometimes. Lethargic. Like run over by truck

Release 5 — day 21, dose 2

2021-03-14

Symptoms: I have had a uti for a month now and no medicine is working

Release 6 — day 28, dose 2

2021-03-23

Symptoms: I have antiresistant uti bacterial infection. On 4th antibiotic now. About to find out if I have thrush due to it. I have also been within 3ft of a covid positive child, but cdc says 3 ft is ok if less then 10 minutes. I generally don't time myself. cut off by CDC

Release 8 — 3 months, dose 2

2021-05-23

Symptoms: Racing heart, higher anxiety and blood pressure

Release 11 — 12 months, dose 2

2022-02-21

Symptoms: Oct 2021 my son and I had covid. We didn't receive any trace and track phone calls.

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	Anxiety	✓	✓	✓
SD	Bacterial infection	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Cystitis	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Hysterectomy	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Urinary tract infection	✓	✓	✓
SD	Uterine dilation and curettage	✓	✓	✓
SD	Uterine polyp	✓	✓	✓
SRO	Asthma	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Lethargy	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sinus congestion	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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