Y5S-12364-61504

3 vaccinations 15 coded responses 26 check-ins 15 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 596 / MT
Registered: 2021-04-12

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

Timeline

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

2021-04-12
Registered in v-safe
2021-04-12
Dose 1 — Moderna
2021-04-12
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Fair · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea

Free text: Not at this time

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Fair · Fever · Chills, Nausea

Free text: General itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Fair · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Itchy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-04-19
Health check-in — day 7, dose 1
Feeling: Poor · Headache, Joint pains · Be unable to do your normal daily activities

Adult check-in
2021-04-26
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-05-03
Survey response — day 21, dose 1
MedDRA: Cough, Rhinorrhoea — Feeling: Fair

Free text: Coughing and runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Dose 2 — Moderna
2021-05-10
Health check-in — day 0, dose 2
Feeling: Fair · Chills, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-05-11
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Poor · Site: Pain, Redness, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: I feel like I was hit by a Mac truck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Survey response — days 1–6 daily, dose 2
MedDRA: Pain of skin — Feeling: Poor · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: My skin hurts

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Fair · Headache, Joint pains

Free text: Itchy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Decreased appetite, Dysgeusia, Insomnia, Pain, Restlessness — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Loss of appetite, pickle taste in mouth for the last four days. I feel like I was hit by a Mac truck then they backed up to make sure they did a good job. Chills were mostly all last night and was very restless and unable to sleep.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Taste disorder — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Still have pickle taste but not as bad though

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-05-17
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-05-24
Survey response — day 14, dose 2
MedDRA: Cold sweat, Diarrhoea, Emergency care, Fatigue, Malaise, Nasopharyngitis, Vomiting — Feeling: Poor · Be unable to work

Free text: Vomiting, diarrhea, extremely tired, cold and clammy.I feel and felt to sick to go to Doctor ER

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-06-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-21
Survey response — day 42, dose 2
MedDRA: Depression — Feeling: Fair

Free text: Depression seems worse

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-09
Survey response — 3 months, dose 2
MedDRA: Cough, Pain, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Coughing, runny nose, general aches and pains all over. Started about 3 days ago.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-20
Dose 3 — Moderna
2021-11-08
Survey response — 6 months, dose 2
MedDRA: Chills, Oropharyngeal pain, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fever, chills, sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — 3 months, dose 3
MedDRA: Office visit, Respiratory disorder, Viral infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Have a viral infection. Upper respiratory. · Healthcare visit (other): Dr. Office

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-01
Call successful
Does not wish to fill out VAERS report
2022-02-20
Survey response — 6 months, dose 3
MedDRA: Cough, Nasal congestion, Pain, Pyrexia, Rhinorrhoea — Feeling: Poor

Free text: Low grade fever, runny nose, stuffy nose, cough general aches.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-12	Moderna
2	2021-05-10	Moderna
3	2021-08-20	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-19	Successful 2021-12-01	Does not wish to fill out VAERS report

Free text

Release 7 — day 0, dose 1

2021-04-12

Systemic reaction (other): Not at this time

Release 7 — days 1–6 daily, dose 1

2021-04-13

Systemic reaction (other): General itching

2021-04-14

Systemic reaction (other): Itchy

Release 8 — day 21, dose 1

2021-05-03

Symptoms: Coughing and runny nose

Release 8 — days 1–6 daily, dose 2

2021-05-11

Systemic reaction (other): I feel like I was hit by a Mac truck

2021-05-12

Systemic reaction (other): My skin hurts

2021-05-13

Systemic reaction (other): Itchy

2021-05-14

Systemic reaction (other): Loss of appetite, pickle taste in mouth for the last four days. I feel like I was hit by a Mac truck then they backed up to make sure they did a good job. Chills were mostly all last night and was very restless and unable to sleep.

2021-05-15

Systemic reaction (other): Still have pickle taste but not as bad though

Release 8 — day 14, dose 2

2021-05-24

Symptoms: Vomiting, diarrhea, extremely tired, cold and clammy.I feel and felt to sick to go to Doctor ER

Release 9 — day 42, dose 2

2021-06-21

Symptoms: Depression seems worse

Release 9 — 3 months, dose 2

2021-08-09

Symptoms: Coughing, runny nose, general aches and pains all over. Started about 3 days ago.

Release 10 — 6 months, dose 2

2021-11-08

Symptoms: Fever, chills, sore throat

Release 10 — 3 months, dose 3

2021-11-19

Symptoms: Have a viral infection. Upper respiratory.

Healthcare visit (other): Dr. Office

Release 11 — 6 months, dose 3

2022-02-20

Symptoms: Low grade fever, runny nose, stuffy nose, cough general aches.

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	Chills	·	·	✓
SD	Cold sweat	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Viral infection	·	·	✓
SD	Vomiting	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain of skin	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Restlessness	✓	✓	✓
SRO	Taste disorder	✓	✓	✓

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