XU6-14084-03475

5 vaccinations 10 coded responses 44 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 668 / KS
Registered: 2021-02-18

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

2021-02-18
Registered in v-safe
2021-02-18
Dose 1 — Moderna
2021-02-18
Survey response — 0 day, dose 1
MedDRA: Fatigue, Pre-existing disease, Rheumatoid arthritis — Feeling: Good · Joint pains, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Nausea, Diarrhea, Abdominal pain · Be unable to work

Adult check-in
2021-02-25
Health check-in — 7 day, dose 1
Feeling: Fair · Diarrhea

Adult check-in
2021-03-04
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-03-11
Survey response — 21 day, dose 1
MedDRA: Nausea, Pyrexia, Vomiting — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-18
Dose 2 — Moderna
2021-03-18
Health check-in — 0 day, dose 2
Feeling: Fair · Joint pains

Adult check-in
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-23
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling hot, Swelling — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Diarrhea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-25
Health check-in — 7 day, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Joint pains

Adult check-in
2021-04-01
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-04-29
Survey response — 42 day, dose 2
MedDRA: Pain, Rheumatoid arthritis, Swelling — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-06-17
Health check-in — 3 month, dose 2
Feeling: Good

Adult check-in
2021-08-17
Dose 3 — Moderna
2021-09-16
Health check-in — 6 month, dose 2
Feeling: Fair

Adult check-in
2021-09-16
Health check-in — 28 day, dose 3
Feeling: Fair

Adult check-in
2021-09-21
Health check-in — 35 day, dose 3
Feeling: Fair

Adult check-in
2021-09-28
Health check-in — 42 day, dose 3
Feeling: Fair

Adult check-in
2021-11-16
Health check-in — 3 month, dose 3
Feeling: Fair

Adult check-in
2022-02-17
Survey response — 6 month, dose 3
MedDRA: Diarrhoea, Food poisoning — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-04-01
Dose 4 — Moderna
2022-04-14
Health check-in — 7 day, dose 4
Feeling: Good · None

Adult check-in
2022-04-15
Health check-in — 14 day, dose 4
Feeling: Good

Adult check-in
2022-04-22
Health check-in — 21 day, dose 4
Feeling: Good

Adult check-in
2022-04-29
Survey response — 28 day, dose 4
MedDRA: Bursitis, Cystitis — Feeling: Poor · Be unable to work or attend school, 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 · check-in answers available
2022-04-29
Report sent to call center — 28 day, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-02
Call successful
Not applicable - Accidental Reporting
2022-05-06
Health check-in — 35 day, dose 4
Feeling: Fair

Adult check-in
2022-05-13
Health check-in — 42 day, dose 4
Feeling: Fair

Adult check-in
2022-07-01
Health check-in — 3 month, dose 4
Feeling: Good

Adult check-in
2022-09-29
Dose 5 — Pfizer-BioNTech
2022-09-30
Health check-in — 6 month, dose 4
Feeling: Fair

Adult check-in
2022-10-07
Health check-in — 7 day, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-15
Health check-in — 14 day, dose 5
Feeling: Good

Adult check-in
2022-10-21
Health check-in — 21 day, dose 5
Feeling: Good

Adult check-in
2022-10-28
Survey response — 28 day, dose 5
MedDRA: Gastroenteritis viral — Feeling: Good · Be unable to work or attend school

MedDRA releases: 2024-11 · check-in answers available
2022-11-03
Health check-in — 35 day, dose 5
Feeling: Good

Adult check-in
2022-11-12
Survey response — 42 day, dose 5
MedDRA: Condition aggravated, Laboratory test abnormal, Liver disorder, Pre-existing disease — Feeling: Fair · 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 · check-in answers available
2022-11-12
Report sent to call center — 42 day, dose 5
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)
2022-11-14
Call successful
Not applicable - Accidental Reporting
2022-12-29
Survey response — 3 month, dose 5
MedDRA: Atrial fibrillation, COVID-19, Emergency care — 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, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11 · check-in answers available
2022-12-29
Report sent to call center — 3 month, dose 5
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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-12-30
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	2021-02-18	Moderna
2	2021-03-18	Moderna
3	2021-08-17	Moderna	No
4	2022-04-01	Moderna	No
5	2022-09-29	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-29	Successful 2022-05-02	Not applicable - Accidental Reporting
2022-11-12	Successful 2022-11-14	Not applicable - Accidental Reporting
2022-12-29	Successful 2022-12-30	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 4

Systemic reaction (other): Normal RA pain/ fatigue.

Release 5

Symptoms: Nausea, vomiting, slight fever. Probably food poisoning.

Systemic reaction (other): Sore throat and ear.

Release 6

Systemic reaction (other): Swollen shoulder is hot to the touch.

Release 8

Symptoms: RA swelling and pain from overwork.

Release 11

Symptoms: Diarrhea without fever. Likely food poisoning.

Symptoms: Bursitis and bladder infection

Release 12

Symptoms: Had a stomach virus for 3 days

Symptoms: I was taken off RA meds 2 weeks ago b/c of bad blood test results. I am dealing with flares and liver issues.

Symptoms: I caught Covid before Thanksgiving and again last week. I was placed on Paxlovid the first time. I had an ER visit for my first A-Fib episode on 12-6 ,didn't have Paxlovid for the Covid infection on 12-22 because my doctor wanted me on heart meds. cut off by CDC

Free-text releases are not linked to a specific 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
SD	Atrial fibrillation	·	·	✓
SD	Bursitis	·	·	✓
SD	Condition aggravated	·	·	✓
SD	COVID-19	·	·	✓
SD	Cystitis	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Food poisoning	·	·	✓
SD	Gastroenteritis viral	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Liver disorder	·	·	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rheumatoid arthritis	✓	✓	✓
SD	Swelling	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rheumatoid arthritis	✓	✓	✓
SRO	Swelling	✓	✓	✓

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