Y49-24019-10339

3 vaccinations 11 coded responses 30 check-ins 11 free-text entries 2 call cases

Sex: —
Age at first dose: 36-40
ZIP prefix: 190 / PA
Registered: 2021-01-25

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-25
Registered in v-safe
2021-01-25
Dose 1 — Moderna
2021-01-25
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Headache — Feeling: Fair · Site: Pain

Free text: Slight headache lastnight.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache

Adult check-in
2021-02-01
Survey response — day 7, dose 1
MedDRA: Pregnancy — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I'm 40 weeks pregnant, so the fatigue is expected

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-02-08
Survey response — day 14, dose 1
MedDRA: Chills — Feeling: Good

Free text: Woke up with postpartum chills

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-01
Dose 2 — Moderna
2021-03-08
Survey response — day 7, dose 2
MedDRA: Chills, Headache — Feeling: Good · Be unable to do your normal daily activities

Free text: Within the first 24hrs of shot I experienced chills and headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 21, dose 2
MedDRA: Cough, Fatigue, Oropharyngeal pain, Rhinorrhoea — Feeling: Good · Be unable to work

Free text: Couching, runny nose, sore throat, and fatigue for 4-5 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-18
Pregnancy registry survey
Pregnant at time of vaccination · Yes, I would like someone to contact me
2021-05-31
Survey response — 3 months, dose 2
MedDRA: Cough, Fatigue, Nasopharyngitis, Oropharyngeal pain — Feeling: Good

Free text: Cold symptoms. Sore throat, couch, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-10-29
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Swollen lymph nodes under left armpit for 3days, but just connecting it to the shot

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — day 7, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-26
Survey response — day 28, dose 3
MedDRA: Nasopharyngitis — Feeling: Fair

Free text: Cold symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Survey response — day 42, dose 3
MedDRA: Nasopharyngitis — Feeling: Good

Free text: Cold symptoms, but no fever

MedDRA releases: 2024-11 · check-in free text available
2022-01-30
Survey response — 3 months, dose 3
MedDRA: Cough — Feeling: Good

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Back injury — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Hurt my back

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-02
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-03-01	Moderna
3	2021-10-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-01	priority 2/3
2022-04-29	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): Slight headache lastnight.

Release 3 — day 7, dose 1

2021-02-01

Systemic reaction (other): I'm 40 weeks pregnant, so the fatigue is expected

Release 3 — day 14, dose 1

2021-02-08

Symptoms: Woke up with postpartum chills

Release 5 — day 7, dose 2

2021-03-08

Systemic reaction (other): Within the first 24hrs of shot I experienced chills and headache

Release 6 — day 21, dose 2

2021-03-22

Symptoms: Couching, runny nose, sore throat, and fatigue for 4-5 days

Release 8 — 3 months, dose 2

2021-05-31

Symptoms: Cold symptoms. Sore throat, couch, fatigue

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Swollen lymph nodes under left armpit for 3days, but just connecting it to the shot

Release 10 — day 28, dose 3

2021-11-26

Symptoms: Cold symptoms

Release 10 — day 42, dose 3

2021-12-12

Symptoms: Cold symptoms, but no fever

Release 11 — 3 months, dose 3

2022-01-30

Symptoms: Cough

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Hurt my back

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	Back injury	·	·	✓
SD	Chills	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Pregnancy	✓	✓	✓

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