Y3M-11041-61334

4 vaccinations 9 coded responses 39 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 46-50
ZIP prefix: 985 / WA
Registered: 2021-04-10

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

Registered dependents

9WX-69220-53792 Child or adolescent in my care · Female · 2022-06-22

Timeline

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

2021-04-10
Registered in v-safe
2021-04-10
Dose 1 — Moderna
2021-04-10
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-16
Survey response — days 1–6 daily, dose 1
MedDRA: Lymphadenopathy — Feeling: Fair

Free text: Swollen glands/lymph nodes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-01
Survey response — day 21, dose 1
MedDRA: Chills, Diarrhoea, Gastroenteritis viral, Pain, Vomiting — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Stomach bugvomiting, diarrhea, body aches, chill

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Dose 2 — Moderna
2021-05-08
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-05-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-15
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-30
Survey response — day 21, dose 2
MedDRA: Menstruation delayed — Feeling: Good

Free text: I have not menstruated in nearly 70 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
Survey response — day 28, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: I previously reported that I had not menstruated in nearly 70 days, but my menses started on day 72 so that is no longer an issue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Survey response — day 35, dose 2
MedDRA: Influenza like illness, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities

Free text: I had onset of flu symptoms 5 days ago. Tested negative for COVID-19 on 6/9/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-09
Survey response — 3 months, dose 2
MedDRA: Cough, Headache, Nasopharyngitis, Oropharyngeal pain, Pain, Respiratory tract congestion, SARS-CoV-2 test negative, Sneezing — Feeling: Good · Be unable to do your normal daily activities

Free text: I had a significant lingering cold (sore throat, cough, congestion, sneezing, body aches, headache) from 7/6/21 through 8/3/21. Tested negative for covid-19 on 7/14/21 with an OTC test.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-06
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-16
Dose 3 — Moderna
2022-05-08
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-09-09
Dose 4 — Moderna
2022-09-09
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-09-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-09-11
Survey response — days 1–6 daily, dose 4
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: Sore throat upon waking (yesterday, too)

MedDRA releases: 2024-11 · check-in free text available
2022-09-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-09-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-16
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
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, Fatigue, Headache, Oropharyngeal pain, Pain, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Congestion, sore throat, cough, fatigue, body aches, headache

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
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
Survey response — 3 months, dose 4
MedDRA: Cough, Haemorrhage, Hysteroscopy abnormal, Nasopharyngitis, Oropharyngeal pain, Pain, Polypectomy, Respiratory tract congestion, Sneezing — 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 · Hospitalization

Free text: Had a terrible cold (cough, sore throat, severe congestion, sneezing, body aches) for over 2 weeks; had hysteroscopy and polypectomy for abnormal bleeding on 12/7/22

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Report sent to call center — 3 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

Hospitalization · 1 call case(s)
2022-12-14
Call successful
Not applicable - Accidental Reporting
2023-03-10
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-10	Moderna
2	2021-05-08	Moderna
3	2021-11-16	Moderna	No
4	2022-09-09	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-12-09	Successful 2022-12-14	Not applicable - Accidental Reporting

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-16

Systemic reaction (other): Swollen glands/lymph nodes

Release 8 — day 21, dose 1

2021-05-01

Symptoms: Stomach bugvomiting, diarrhea, body aches, chill

Release 8 — day 21, dose 2

2021-05-30

Symptoms: I have not menstruated in nearly 70 days

Release 8 — day 28, dose 2

2021-06-05

Symptoms: I previously reported that I had not menstruated in nearly 70 days, but my menses started on day 72 so that is no longer an issue.

Release 9 — day 35, dose 2

2021-06-12

Symptoms: I had onset of flu symptoms 5 days ago. Tested negative for COVID-19 on 6/9/21

Release 9 — 3 months, dose 2

2021-08-09

Symptoms: I had a significant lingering cold (sore throat, cough, congestion, sneezing, body aches, headache) from 7/6/21 through 8/3/21. Tested negative for covid-19 on 7/14/21 with an OTC test.

Release 12 — days 1–6 daily, dose 4

2022-09-11

Systemic reaction (other): Sore throat upon waking (yesterday, too)

Release 12 — day 21, dose 4

2022-09-30

Symptoms: Congestion, sore throat, cough, fatigue, body aches, headache

Release 12 — 3 months, dose 4

2022-12-09

Symptoms: Had a terrible cold (cough, sore throat, severe congestion, sneezing, body aches) for over 2 weeks; had hysteroscopy and polypectomy for abnormal bleeding on 12/7/22

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
SD	Chills	✓	✓	✓
SD	Cough	✓	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Gastroenteritis viral	✓	✓	✓
SD	Haemorrhage	·	·	✓
SD	Headache	✓	·	✓
SD	Hysteroscopy abnormal	·	·	✓
SD	Influenza like illness	✓	✓	✓
SD	Menstruation delayed	✓	✓	✓
SD	Nasopharyngitis	✓	·	✓
SD	Oropharyngeal pain	✓	·	✓
SD	Pain	✓	✓	✓
SD	Polypectomy	·	·	✓
SD	Respiratory tract congestion	✓	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sneezing	✓	·	✓
SD	Unevaluable event	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Oropharyngeal pain	·	·	✓

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