Y4B-17787-34418

5 vaccinations 30 coded responses 59 check-ins 30 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 223 / VA
Registered: 2021-02-05

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Survey response — day 0, dose 1
MedDRA: Asthma, Cough, Pre-existing disease — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Asthma cough in the beginning but inhaler not requiref

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Pre-existing disease — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Decrease in peak flow and asthma cough requiring use of Albuterol jnhaler

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Asthma, Cough — Feeling: Good · Site: Pain · Muscle or body aches, Abdominal pain

Free text: Asthmaccough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Cough variant asthma — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Asthma cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Asthma, Cough — Feeling: Fair · Muscle or body aches, Abdominal pain

Free text: Asthma cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Asthma, Cough — Feeling: Good · Muscle or body aches, Abdominal pain

Free text: Asthma cough - mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Asthma, Cough, Pre-existing disease — Feeling: Good · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Asthma cough - mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — day 7, dose 1
MedDRA: Asthma, Cough, Pre-existing disease — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Asthma cough - mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Blood pressure increased, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Asthma attack with peak flow dropping to 296 and elevated blood pressure. Asthma responded well to Albuterol inhaler. Not taking meds for BP. Tried biofeedback technique which helpsd a bit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Blood pressure increased — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Asthma and ejevated blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Blood pressure increased, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Asthma attack and elevated blood pressure. Asthma responding well to Albutetol inhaler but have no meds to reduce BP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Blood pressure increased, Hypertension, Unevaluable event — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Asthma attack and elevated blood pressure&mom

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure increased, Oedema — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Elevated blood pressure and edema. I will talk to doctor on 16 Mar about elevated BP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure increased, Office visit — Feeling: Good · Headache, Fatigue or tiredness

Free text: Elevated blood pressure. I see my doctor on 16 March

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 7, dose 2
MedDRA: Blood pressure increased — Feeling: Good · Headache, Fatigue or tiredness

Free text: Elevated blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Survey response — day 28, dose 2
MedDRA: End stage renal disease, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Not related to vaccine but diagnosed with stage 5 - end stage renal disease · Healthcare visit (other): Vein mapping and consult for fistula surgery on Apr 26

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Survey response — day 35, dose 2
MedDRA: End stage renal disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diagnosed witg End Stage Renal Disease not relaged to COVID or vaccine

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

1 call case(s)
2021-04-16
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Anaemia, End stage renal disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Diagnosed with End Stage Renal Disease & anemia. GFR is 11 w/toxins leading to allergic reactions & shortage of breath. Also had fistula surgery on left arm preparing for dialysis. I do wonder if my body is capable of making antibodies & still mask

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-10
Call successful
Participant prefers to complete VAERS report online
2021-09-03
Survey response — 6 months, dose 2
MedDRA: Anaemia, End stage renal disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Anemia related to ESRD. Im considered stable so not yet on dialysis. Taking iron supplement for anemia

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-08
Call 1 — Left Voicemail
2021-09-23
Dose 3 — Moderna
2021-09-23
Health check-in — day 0, dose 3
Feeling: Fair · None

Adult check-in
2021-09-24
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma — Feeling: Fair · Site: Pain · Headache

Free text: Mild asthma attack in early morning. Proair inhaler worked to stop it

MedDRA releases: 2024-11 · check-in free text available
2021-09-25
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma — Feeling: Good · Site: Pain, Itching

Free text: Mild asthma attack handled with Proair inhaler

MedDRA releases: 2024-11 · check-in free text available
2021-09-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-09-27
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain

Free text: Mild asthma attack manageable with ProAir inhaler

MedDRA releases: 2024-11 · check-in free text available
2021-09-28
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma — Feeling: Fair · Site: Pain, Itching

Free text: Asthma attack. Had to take Proair inhaler twice this morning

MedDRA releases: 2024-11 · check-in free text available
2021-09-29
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain, Itching · Muscle or body aches

Free text: Asthma attack in the early morning resolved with use of Proair inhaler

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Survey response — day 7, dose 3
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain, Itching · Muscle or body aches

Free text: Mild Asthma attack in morning

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-14
Survey response — day 21, dose 3
MedDRA: Arthralgia, Arthropathy, Office visit, Physiotherapy, Vertigo, Vertigo positional — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Extteme pain in upper right shoulder about 2 weeks ago. Bppv vertiho attack yesterday · Healthcare visit (other): Physical therapist for shoulder and ENT nurse for vertigo reset

MedDRA releases: 2024-11 · check-in free text available
2021-10-14
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-11-17
Call 1 — Left Voicemail
2021-12-23
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-03-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-12
Dose 4 — Moderna
2022-04-14
Survey response — days 1–6 daily, dose 4
MedDRA: Adverse reaction, Asthma, Self-medication — Feeling: Fair · Site: Pain

Free text: Mild asthma and allergy symptoms after shot but manageable with Benadryl and inhaler

MedDRA releases: 2024-11 · check-in free text available
2022-04-15
Survey response — days 1–6 daily, dose 4
MedDRA: Asthma, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: A bit of asthma but manageable with ProAir inhaler

MedDRA releases: 2024-11 · check-in free text available
2022-04-16
Survey response — days 1–6 daily, dose 4
MedDRA: Asthma — Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site

Free text: Mild asthma symptoms manageable with inhaler and Benadryl

MedDRA releases: 2024-11 · check-in free text available
2022-04-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-19
Survey response — day 7, dose 4
MedDRA: Pruritus — Feeling: Fair · Fatigue or tiredness

Free text: Itching on arm

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-14
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-09-19
Dose 5 — Moderna
2022-10-12
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2022-10-14
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-10-17
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-10-24
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-10-31
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-19
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-03-20
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-09-23	Moderna	No
4	2022-04-12	Moderna	No
5	2022-09-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-02	Successful
2021-04-09	Successful
2021-06-04	Successful 2021-06-10	Participant prefers to complete VAERS report online
2021-09-03	Unsuccessful
2021-10-14	Unsuccessful

Free text

Release 3 — day 0, dose 1

2021-02-05

Systemic reaction (other): Asthma cough in the beginning but inhaler not requiref

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): Decrease in peak flow and asthma cough requiring use of Albuterol jnhaler

2021-02-07

Systemic reaction (other): Asthmaccough

2021-02-08

Systemic reaction (other): Asthma cough

2021-02-09

Systemic reaction (other): Asthma cough

2021-02-10

Systemic reaction (other): Asthma cough - mild

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): Asthma cough - mild

Release 4 — day 7, dose 1

2021-02-12

Systemic reaction (other): Asthma cough - mild

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Asthma attack with peak flow dropping to 296 and elevated blood pressure. Asthma responded well to Albuterol inhaler. Not taking meds for BP. Tried biofeedback technique which helpsd a bit

2021-03-07

Systemic reaction (other): Asthma and ejevated blood pressure

2021-03-08

Systemic reaction (other): Asthma attack and elevated blood pressure. Asthma responding well to Albutetol inhaler but have no meds to reduce BP

2021-03-09

Systemic reaction (other): Asthma attack and elevated blood pressure&mom

2021-03-10

Systemic reaction (other): Elevated blood pressure and edema. I will talk to doctor on 16 Mar about elevated BP

2021-03-11

Systemic reaction (other): Elevated blood pressure. I see my doctor on 16 March

Release 5 — day 7, dose 2

2021-03-12

Systemic reaction (other): Elevated blood pressure

Release 6 — day 28, dose 2

2021-04-02

Symptoms: Not related to vaccine but diagnosed with stage 5 - end stage renal disease

Healthcare visit (other): Vein mapping and consult for fistula surgery on Apr 26

Release 7 — day 35, dose 2

2021-04-09

Symptoms: Diagnosed witg End Stage Renal Disease not relaged to COVID or vaccine

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: Diagnosed with End Stage Renal Disease & anemia. GFR is 11 w/toxins leading to allergic reactions & shortage of breath. Also had fistula surgery on left arm preparing for dialysis. I do wonder if my body is capable of making antibodies & still mask cut off by CDC

Release 9 — 6 months, dose 2

2021-09-03

Symptoms: Anemia related to ESRD. Im considered stable so not yet on dialysis. Taking iron supplement for anemia

Release 9 — days 1–6 daily, dose 3

2021-09-24

Systemic reaction (other): Mild asthma attack in early morning. Proair inhaler worked to stop it

2021-09-25

Systemic reaction (other): Mild asthma attack handled with Proair inhaler

2021-09-27

Systemic reaction (other): Mild asthma attack manageable with ProAir inhaler

2021-09-28

Systemic reaction (other): Asthma attack. Had to take Proair inhaler twice this morning

2021-09-29

Systemic reaction (other): Asthma attack in the early morning resolved with use of Proair inhaler

Release 9 — day 7, dose 3

2021-09-30

Systemic reaction (other): Mild Asthma attack in morning

Release 10 — day 21, dose 3

2021-10-14

Symptoms: Extteme pain in upper right shoulder about 2 weeks ago. Bppv vertiho attack yesterday

Healthcare visit (other): Physical therapist for shoulder and ENT nurse for vertigo reset

Release 11 — days 1–6 daily, dose 4

2022-04-14

Systemic reaction (other): Mild asthma and allergy symptoms after shot but manageable with Benadryl and inhaler

2022-04-15

Systemic reaction (other): A bit of asthma but manageable with ProAir inhaler

2022-04-16

Systemic reaction (other): Mild asthma symptoms manageable with inhaler and Benadryl

Release 11 — day 7, dose 4

2022-04-19

Systemic reaction (other): Itching on arm

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	Arthropathy	·	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Physiotherapy	·	·	✓
HCVO	Vertigo	·	·	✓
SD	Anaemia	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	End stage renal disease	✓	✓	✓
SD	Vertigo positional	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Asthma	✓	✓	✓
SRO	Blood pressure increased	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Cough variant asthma	✓	✓	✓
SRO	Hypertension	✓	✓	○
SRO	Oedema	✓	✓	✓
SRO	Office visit	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	·	·	✓
SRO	Self-medication	·	·	✓
SRO	Unevaluable event	·	·	✓

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