W3X-29003-42534
4 vaccinations
4 coded responses
34 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 913 / CA
- Registered
- 2021-03-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
6PU-30739-64000
Child or adolescent in my care · Female · 2022-06-27
Timeline
-
2021-03-12
Registered in v-safe
-
2021-03-12
Dose 1 — Moderna
- 2021-03-12
-
2021-03-13
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Joint pains, Fatigue or tirednessAdult check-in
-
2021-03-14
Survey response — days 1–6 daily, dose 1MedDRA: Respiratory tract congestion, Rhinorrhoea — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Runny nose, slight congestionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
-
2021-04-09
Dose 2 — Moderna
- 2021-04-09
-
2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Swelling · Joint pains, Fatigue or tirednessAdult check-in
- 2021-04-11
- 2021-04-12
- 2021-04-13
-
2021-04-14
Survey response — days 1–6 daily, dose 2MedDRA: Decreased appetite, Poor quality sleep — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Pumped breastmilk fed baby with decreased appetite and poor sleepMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-15
Survey response — days 1–6 daily, dose 2MedDRA: Breast feeding, Decreased appetite, Vomiting — Feeling: Good · Joint painsFree text: Pumped Breastmilk fed baby vomiting last night, continued decreased appetiteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-16
- 2021-04-23
- 2021-04-30
- 2021-05-07
- 2021-05-14
- 2021-05-21
- 2021-07-10
- 2021-10-08
-
2021-11-05
Dose 3 — Moderna
- 2022-04-10
- 2022-05-06
-
2022-07-18
Dose 4 — Pfizer-BioNTech
- 2022-08-01
- 2022-08-08
- 2022-08-17
- 2022-08-22
- 2022-08-29
-
2022-10-17
Survey response — 3 months, dose 4MedDRA: Office visit, Pregnancy — 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 professionalFree text: Symptoms: 10 weeks pregnant with significant nausea and vomiting. · Healthcare visit (other): Ob/gynMedDRA releases: 2024-11 · check-in free text available
-
2022-10-17
Report sent to call center — 3 months, dose 4Be 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)
-
2022-10-18
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-01-16
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Moderna | |
| 2 | 2021-04-09 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-07-18 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-17 | Successful 2022-10-18 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Runny nose, slight congestion
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Pumped breastmilk fed baby with decreased appetite and poor sleep
Systemic reaction (other): Pumped Breastmilk fed baby vomiting last night, continued decreased appetite
Release 12 — 3 months, dose 4
Symptoms: 10 weeks pregnant with significant nausea and vomiting.
Healthcare visit (other): Ob/gyn
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 | Office visit | · | · | ✓ |
| SD | Pregnancy | · | · | ✓ |
| SRO | Breast feeding | ✓ | ✓ | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | Poor quality sleep | ✓ | ✓ | ✓ |
| SRO | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
| SRO | Vomiting | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release