WLX-14118-65424

4 vaccinations 8 coded responses 25 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 210 / MD
Registered: 2021-08-08

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

QXZ-81716-19023 Child or adolescent in my care · Male · 2021-11-07

XGG-31952-59778 Child or adolescent in my care · Male · 2021-11-07

WTN-54861-38222 Child or adolescent in my care · Female · 2022-06-20

PM4-33675-98562 Child or adolescent in my care · Female · 2022-06-20

Timeline

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

2021-04-02
Dose 1 — Pfizer-BioNTech
2021-04-23
Dose 2 — Pfizer-BioNTech
2021-08-08
Registered in v-safe
2021-10-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-07
Dose 3 — Moderna
2021-11-07
Survey response — day 0, dose 3
MedDRA: Pharyngeal swelling, Self-medication, Swollen tongue — Feeling: Good

Free text: Mild swelling of tongue and throat, treated with Benadryl

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-11-14
Health check-in — day 7, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-11-21
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-07
Health check-in — day 28, dose 3
Feeling: Good

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

Adult check-in
2021-12-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-06
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-08
Survey response — 6 months, dose 3
MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities

Free text: A terrible cold that was not COVID (multiple rapids and PCR were negative).

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Dose 4 — Moderna
Co-administered: Flu
2022-09-10
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Redness, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-09-11
Survey response — days 1–6 daily, dose 4
MedDRA: Toothache — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Forgot to mention yesterday that I've been having teeth pain yesterday and today.

MedDRA releases: 2024-11 · check-in free text available
2022-09-12
Survey response — days 1–6 daily, dose 4
MedDRA: Axillary pain, Oedema peripheral, Pain, Pruritus, Swelling — Feeling: Good · Site: Redness · Fever · Rash, not including the immediate area around the injection site

Free text: Itching, swelling, pain, and redness between injection site and armpit

MedDRA releases: 2024-11 · check-in free text available
2022-09-16
Survey response — day 7, dose 4
MedDRA: Axillary mass — Feeling: Good

Free text: Lump near armpit on non-COVID booster arm.

MedDRA releases: 2024-11 · check-in free text available
2022-09-23
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-09-30
Survey response — day 21, dose 4
MedDRA: Cough, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Runny nose, congestion, sore throat, cough

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Survey response — day 28, dose 4
MedDRA: Conjunctivitis — 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

Free text: Conjunctivitis

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Report sent to call center — day 28, 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)
2022-10-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-14
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-09
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-10
Survey response — 6 months, dose 4
MedDRA: Nasopharyngitis, Office visit — 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 professional

MedDRA releases: 2024-11
2023-03-10
Report sent to call center — 6 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2023-03-13
Call 1 — Left Voicemail
2023-06-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Pfizer-BioNTech	No
2	2021-04-23	Pfizer-BioNTech	No
3	2021-11-07	Moderna	No
4	2022-09-09	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-10-07	Successful 2022-10-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-10	Successful 2023-06-16	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 10 — day 0, dose 3

2021-11-07

Systemic reaction (other): Mild swelling of tongue and throat, treated with Benadryl

Release 11 — 6 months, dose 3

2022-05-08

Symptoms: A terrible cold that was not COVID (multiple rapids and PCR were negative).

Release 12 — days 1–6 daily, dose 4

2022-09-11

Systemic reaction (other): Forgot to mention yesterday that I've been having teeth pain yesterday and today.

2022-09-12

Systemic reaction (other): Itching, swelling, pain, and redness between injection site and armpit

Release 12 — day 7, dose 4

2022-09-16

Systemic reaction (other): Lump near armpit on non-COVID booster arm.

Release 12 — day 21, dose 4

2022-09-30

Symptoms: Runny nose, congestion, sore throat, cough

Release 12 — day 28, dose 4

2022-10-07

Symptoms: Conjunctivitis

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	Conjunctivitis	·	·	✓
SD	Cough	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Axillary mass	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Oedema peripheral	·	·	✓
SRO	Pain	·	·	✓
SRO	Pharyngeal swelling	·	·	✓
SRO	Pruritus	·	·	✓
SRO	Self-medication	·	·	✓
SRO	Swelling	·	·	✓
SRO	Swollen tongue	·	·	✓
SRO	Toothache	·	·	✓

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