W4L-17166-71923

4 vaccinations 19 coded responses 55 check-ins 18 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 333 / FL
Registered: 2021-03-09

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

LE9-13633-05389 Child or adolescent in my care · Female · 2022-06-24

SHT-13861-63167 Child or adolescent in my care · Female · 2022-06-24

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Moderna
2021-03-09
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Survey response — day 7, dose 1
MedDRA: Cough, Insomnia, Wheezing — Feeling: Fair · Fatigue or tiredness

Free text: Coughing, wheezing, insomnia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Nausea

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Dizziness, Ear pain, Gastrointestinal motility disorder, Throat irritation — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Dizziness, ear ache, tickle in my throat, bowels slowed down, appetite lower

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Headache

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-20
Survey response — day 14, dose 2
MedDRA: Insomnia — Feeling: Good

Free text: Bad dreams, trouble sleeping

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Survey response — day 28, dose 2
MedDRA: Migraine — Feeling: Poor

Free text: Migraines

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — day 35, dose 2
MedDRA: Migraine — Feeling: Fair

Free text: Worsening migraines

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Survey response — day 42, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair

Free text: Worsening back soreness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-19
Dose 3 — Moderna
Co-administered: Flu
2021-11-19
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-20
Survey response — days 1–6 daily, dose 3
MedDRA: Asthenia, Dizziness, Dysmenorrhoea, Pre-existing disease — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Menstrual cramps (despite being post-menopausal for years). Dizzy and weak.

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · None

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-25
Survey response — days 1–6 daily, dose 3
MedDRA: Insomnia — Feeling: Fair · Chills, Headache

Free text: Difficulty sleeping

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Survey response — day 7, dose 3
MedDRA: Insomnia — Feeling: Fair · Abdominal pain

Free text: Insomnia

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Survey response — day 14, dose 3
MedDRA: Fatigue, Insomnia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue, insomnia

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Survey response — day 21, dose 3
MedDRA: Cough, Oropharyngeal pain, Rhinovirus infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rhinovirus, cough, sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 28, dose 3
MedDRA: Cough, Nasopharyngitis — Feeling: Poor · Be unable to do your normal daily activities

Free text: Cough, cold

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-31
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-18
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-20
Survey response — 6 months, dose 3
MedDRA: Ectopic 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 professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Ectopic pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Report sent to call center — 6 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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-05-24
Call 1 — Left Voicemail
2022-06-03
Call successful
Participant prefers to complete VAERS report online
2022-07-15
Dose 4 — Pfizer-BioNTech
2022-07-15
Health check-in — day 0, dose 4
Feeling: Fair · None

Adult check-in
2022-07-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Diarrhea

Adult check-in
2022-07-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-18
Survey response — days 1–6 daily, dose 4
MedDRA: Lymph node pain — Feeling: Good · Site: Itching

Free text: Painful lymph node under arm that got the vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-07-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-07-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-07-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-07-22
Health check-in — day 7, dose 4
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-07-29
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-05
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-08-12
Survey response — day 28, dose 4
MedDRA: Diarrhoea — Feeling: Fair

Free text: Diarrhea (probably from antibiotic and not from COVID vaccine)

MedDRA releases: 2024-11 · check-in free text available
2022-08-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-08-26
Survey response — day 42, dose 4
MedDRA: Salpingectomy, Surgery — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had surgery to remove Fallopian tubes and to have uterine biopsy. · Healthcare visit (other): Outpatient surgery at a hospital

MedDRA releases: 2024-11 · check-in free text available
2022-08-26
Report sent to call center — day 42, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-14
Survey response — 3 months, dose 4
MedDRA: Nasal congestion, Respiratory tract congestion, Throat irritation — Feeling: Fair

Free text: Scratchy throat, stuffy nose, congestion

MedDRA releases: 2024-11 · check-in free text available
2023-01-13
Survey response — 6 months, dose 4
MedDRA: Abortion spontaneous, Biochemical pregnancy, Bronchitis, Ectopic pregnancy, Nasopharyngitis, Nephrolithiasis, Pharyngitis streptococcal — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-13
Report sent to call center — 6 months, dose 4
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)
2023-01-16
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna
3	2021-11-19	Moderna	Flu
4	2022-07-15	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-20	Successful 2022-06-03	Participant prefers to complete VAERS report online
2022-08-26	Successful 2022-08-30	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-01-13	Unsuccessful

Free text

Release 5 — day 7, dose 1

2021-03-16

Systemic reaction (other): Coughing, wheezing, insomnia

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Dizziness, ear ache, tickle in my throat, bowels slowed down, appetite lower

2021-04-11

Systemic reaction (other): Dizziness

Release 7 — day 14, dose 2

2021-04-20

Symptoms: Bad dreams, trouble sleeping

Release 8 — day 28, dose 2

2021-05-04

Symptoms: Migraines

Release 8 — day 35, dose 2

2021-05-11

Symptoms: Worsening migraines

Release 8 — day 42, dose 2

2021-05-18

Symptoms: Worsening back soreness

Release 10 — days 1–6 daily, dose 3

2021-11-20

Systemic reaction (other): Menstrual cramps (despite being post-menopausal for years). Dizzy and weak.

2021-11-25

Systemic reaction (other): Difficulty sleeping

Release 10 — day 7, dose 3

2021-11-26

Systemic reaction (other): Insomnia

Release 10 — day 14, dose 3

2021-12-03

Symptoms: Fatigue, insomnia

Release 10 — day 21, dose 3

2021-12-10

Symptoms: Rhinovirus, cough, sore throat

Release 10 — day 28, dose 3

2021-12-17

Symptoms: Cough, cold

Release 11 — 6 months, dose 3

2022-05-20

Symptoms: Ectopic pregnancy

Release 12 — days 1–6 daily, dose 4

2022-07-18

Systemic reaction (other): Painful lymph node under arm that got the vaccine

Release 12 — day 28, dose 4

2022-08-12

Symptoms: Diarrhea (probably from antibiotic and not from COVID vaccine)

Release 12 — day 42, dose 4

2022-08-26

Symptoms: Had surgery to remove Fallopian tubes and to have uterine biopsy.

Healthcare visit (other): Outpatient surgery at a hospital

Release 12 — 3 months, dose 4

2022-10-14

Symptoms: Scratchy throat, stuffy nose, congestion

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	Biochemical pregnancy	·	·	✓
SD	Bronchitis	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Ectopic pregnancy	·	·	✓
SD	Fatigue	·	·	✓
SD	Insomnia	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nephrolithiasis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pharyngitis streptococcal	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinovirus infection	·	·	✓
SD	Salpingectomy	·	·	✓
SD	Throat irritation	·	·	✓
SRO	Asthenia	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysmenorrhoea	·	·	✓
SRO	Ear pain	✓	✓	✓
SRO	Gastrointestinal motility disorder	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Lymph node pain	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Throat irritation	✓	✓	✓
SRO	Wheezing	✓	✓	✓

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