Y55-31533-88452

5 vaccinations 6 coded responses 31 check-ins 5 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 760 / TX
Registered: 2021-01-23

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

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Moderna
2021-01-23
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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 — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-20
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-21
Dose 2 — Moderna
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Erythema, Fatigue, Limb discomfort, Nausea, Pain, Pruritus, Pyrexia — Feeling: Good · Chills, Headache, Fatigue or tiredness, Nausea

Free text: I had the 2nd shot 6 days ago. I had minor pain, redness, and itching for 4 days. I had fever and bad chills early the next morning. Also some nausea and fatigue. By 9 am that same day, I felt fine other than the slight soreness in my arm. My 2nd dose was delayed because of the (b)(6) weather.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-16
Survey response — day 21, dose 2
MedDRA: Ear pain, Neck pain, Pain in jaw, Pharyngeal swelling — 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

Free text: Swelling in throat, pain in left side of neck and at TMJ and left ear. Felt like a lump in throat and my swallowing muscles weren't working as well as usual. Covid-19 test neg 3/9/21. Tried to send 3/14/21 when feeling poor.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-21
Survey response — day 28, dose 2
MedDRA: Decreased appetite, Ear pain, Muscle spasms, Nausea, Office visit, Pain in jaw — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Still having left ear pain and sore jaw (left side only). Nausea and cramping, lack of appetite. Vaccine 1 and 2 given to left arm. · Healthcare visit (other): Spoke to Dr office. Have in person appt tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-28
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-04
Survey response — day 42, dose 2
MedDRA: Ear pain, Facial pain, Hypoaesthesia, Lymphadenopathy — Feeling: Fair · Be unable to do your normal daily activities

Free text: Still swollen lymph glands and ear pain w/ some pain and numbness on left side of lower cheek.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-22
Survey response — 6 months, dose 2
MedDRA: Dysphagia, Gastrointestinal disorder, Laryngospasm, Lung disorder, Office visit, Pre-existing disease, Vagus nerve disorder — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I've had a chronic cough since March 2021. And some trouble swallowing. Had some laryngospasms. Being tested for GI and lung issues. No definitive diagnosis yet. No fevers or fatigue. ENT thought my vagus nerve is irritated, causing symptoms. · Healthcare visit (other): Saw PCP, ENT(rhino laryngoscope), GI(upper GI & 2 different swallow tests), pulmonologist(prescribed Trelegy & scheduled a lung function test)

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-22
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call successful
Participant prefers to complete VAERS report online
2021-08-24
Call successful
Participant prefers to complete VAERS report online
2021-08-24
Call successful
Participant prefers to complete VAERS report online
2021-11-12
Dose 3 — Pfizer-BioNTech
2022-02-21
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-13
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-06-16
Dose 4 — Pfizer-BioNTech
2022-11-01
Dose 5 — Pfizer-BioNTech
2022-11-12
Health check-in — day 7, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-11-15
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-22
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-29
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-12-06
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-12-13
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-31
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-05-02
Survey response — 6 months, dose 5
MedDRA: Fall, Upper limb fracture — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-05-02
Report sent to call center — 6 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2023-05-03
Call 1 — Left Voicemail
2023-05-03
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	2021-01-23	Moderna
2	2021-02-21	Moderna
3	2021-11-12	Pfizer-BioNTech	No
4	2022-06-16	Pfizer-BioNTech	No
5	2022-11-01	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-16	Successful 2021-08-24	Participant prefers to complete VAERS report online
2021-03-21	Successful 2021-08-24	Participant prefers to complete VAERS report online
2021-08-22	Successful 2021-08-24	Participant prefers to complete VAERS report online
2023-05-02	Successful 2023-05-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): I had the 2nd shot 6 days ago. I had minor pain, redness, and itching for 4 days. I had fever and bad chills early the next morning. Also some nausea and fatigue. By 9 am that same day, I felt fine other than the slight soreness in my arm. My 2nd dose was delayed because of the (b)(6) weather.

redacted (b)(6)

Release 5 — day 21, dose 2

2021-03-16

Symptoms: Swelling in throat, pain in left side of neck and at TMJ and left ear. Felt like a lump in throat and my swallowing muscles weren't working as well as usual. Covid-19 test neg 3/9/21. Tried to send 3/14/21 when feeling poor.

Release 6 — day 28, dose 2

2021-03-21

Symptoms: Still having left ear pain and sore jaw (left side only). Nausea and cramping, lack of appetite. Vaccine 1 and 2 given to left arm.

Healthcare visit (other): Spoke to Dr office. Have in person appt tomorrow

Release 6 — day 42, dose 2

2021-04-04

Symptoms: Still swollen lymph glands and ear pain w/ some pain and numbness on left side of lower cheek.

Release 9 — 6 months, dose 2

2021-08-22

Symptoms: I've had a chronic cough since March 2021. And some trouble swallowing. Had some laryngospasms. Being tested for GI and lung issues. No definitive diagnosis yet. No fevers or fatigue. ENT thought my vagus nerve is irritated, causing symptoms.

Healthcare visit (other): Saw PCP, ENT(rhino laryngoscope), GI(upper GI & 2 different swallow tests), pulmonologist(prescribed Trelegy & scheduled a lung function test)

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	Office visit	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Dysphagia	✓	·	✓
SD	Ear pain	✓	✓	✓
SD	Facial pain	✓	✓	✓
SD	Fall	·	·	✓
SD	Gastrointestinal disorder	✓	·	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Laryngospasm	✓	·	✓
SD	Lung disorder	✓	·	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Office visit	✓	·	✓
SD	Pain in jaw	✓	✓	✓
SD	Pharyngeal swelling	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Upper limb fracture	·	·	✓
SD	Vagus nerve disorder	✓	·	✓
SRO	Chills	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Limb discomfort	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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