XK3-31813-20266

4 vaccinations 5 coded responses 44 check-ins 5 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 627 / IL
Registered: 2021-03-18

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

Registered dependents

QXQ-26610-76066 Child or adolescent in my care · Male · 2021-11-23

5JB-17227-81786 Child or adolescent in my care · Male · 2022-06-20

Timeline

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

2021-03-18
Registered in v-safe
2021-03-18
Dose 1 — Moderna
2021-03-18
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-15
Dose 2 — Moderna
2021-04-15
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Paraesthesia — Feeling: Fair · Chills, Headache, Fatigue or tiredness

Free text: Dizziness and tingling hands

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Limb discomfort, Paraesthesia — Feeling: Fair · Muscle or body aches

Free text: Heavy limbs, tingling in hands

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness, Nausea, Vomiting · Be unable to work

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-22
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-20
Survey response — day 35, dose 2
MedDRA: Autoimmune disorder — Feeling: Good

Free text: Auto immune issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-15
Survey response — 3 months, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fatigue

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-14
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-23
Dose 3 — Moderna
2021-11-23
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache

Adult check-in
2021-11-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-30
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-07
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-14
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-12-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-19
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-11-25
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-11-25
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-30
Survey response — day 42, dose 4
MedDRA: Blood pressure abnormal, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Blood pressure issues · Healthcare visit (other): Ultrasound

MedDRA releases: 2024-11 · check-in free text available
2022-11-30
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-02
Call 1 — Left Voicemail
2023-01-18
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2023-04-19
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-18	Moderna
2	2021-04-15	Moderna
3	2021-11-23	Moderna	No
4	2022-10-19	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-11-30	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-17

Systemic reaction (other): Dizziness and tingling hands

2021-04-19

Systemic reaction (other): Heavy limbs, tingling in hands

Release 8 — day 35, dose 2

2021-05-20

Symptoms: Auto immune issues

Release 9 — 3 months, dose 2

2021-07-15

Symptoms: Fatigue

Release 12 — day 42, dose 4

2022-11-30

Symptoms: Blood pressure issues

Healthcare visit (other): Ultrasound

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	Autoimmune disorder	✓	✓	✓
SD	Blood pressure abnormal	·	·	✓
SD	Fatigue	✓	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Limb discomfort	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓

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