XLB-29763-18819

3 vaccinations 5 coded responses 34 check-ins 5 free-text entries 4 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 983 / WA
Registered: 2021-01-08

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

2021-01-08
Registered in v-safe
2021-01-08
Dose 1 — Moderna
2021-01-08
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-05
Dose 2 — Moderna
2021-02-05
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Difficulty sleeping.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-13
Survey response — day 35, dose 2
MedDRA: Ear congestion, Oropharyngeal pain, SARS-CoV-2 test negative, Sinus congestion — Feeling: Fair · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Sore throat, sinus and ear congestion · Healthcare visit (other): Covid test was negative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 35, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 42, dose 2
MedDRA: Ear infection, Ear, nose and throat examination — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Ear infection · Healthcare visit (other): Outpatient ent visit scheduled for next week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-08
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-17
Dose 3 — Moderna
2021-11-18
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-24
Health check-in — day 7, dose 3
Feeling: Good · Headache, Nausea

Adult check-in
2021-12-01
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-22
Survey response — day 35, dose 3
MedDRA: Nasopharyngitis — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Cold

MedDRA releases: 2024-11 · check-in free text available
2021-12-22
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-29
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-16
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-18
Survey response — 6 months, dose 3
MedDRA: COVID-19, Sinusitis — 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 · Telehealth, virtual health, or email health consultation

Free text: Had Covid which led to a sinus infection

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
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 · 1 call case(s)
2022-05-19
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	2021-01-08	Moderna
2	2021-02-05	Moderna
3	2021-11-17	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-13	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-03-19	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-22	Successful 2021-12-23	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-18	Successful 2022-05-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-06

Systemic reaction (other): Difficulty sleeping.

Release 5 — day 35, dose 2

2021-03-13

Symptoms: Sore throat, sinus and ear congestion

Healthcare visit (other): Covid test was negative

Release 6 — day 42, dose 2

2021-03-19

Symptoms: Ear infection

Healthcare visit (other): Outpatient ent visit scheduled for next week.

Release 10 — day 35, dose 3

2021-12-22

Symptoms: Cold

Release 11 — 6 months, dose 3

2022-05-18

Symptoms: Had Covid which led to a sinus infection

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	Ear, nose and throat examination	✓	✓	✓
HCVO	SARS-CoV-2 test negative	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Ear congestion	✓	✓	✓
SD	Ear infection	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Sinus congestion	✓	✓	✓
SD	Sinusitis	·	·	✓
SRO	Insomnia	✓	✓	✓

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