Y6B-27996-54293

3 vaccinations 6 coded responses 40 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 939 / CA
Registered: 2021-03-15

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

2021-03-15
Registered in v-safe
2021-03-15
Dose 1 — Moderna
2021-03-15
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Breast pain — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Breast pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Pain — Feeling: Good

Free text: Last night after I had checked in I felt achy/chills, but I woke up today feeling fine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — day 7, dose 1
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2021-03-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-12
Dose 2 — Moderna
2021-04-12
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-03
Survey response — day 21, dose 2
MedDRA: Bedridden, Dizziness, Migraine, Pain, Photophobia — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: When I started my menstrual cycle last Wednesday 4/28/2021 I had a horrible migraine that kept me bedridden most of the day. Pain and dizziness with sensitivity to light and noise.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-06
Dose 3 — Moderna
2021-11-06
Health check-in — day 0, dose 3
Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-13
Health check-in — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-20
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-05
Survey response — 3 months, dose 3
MedDRA: COVID-19 — 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 · Telehealth, virtual health, or email health consultation

Free text: I contracted covid

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-30
Call 1 — Could Not Reach Participant
2022-04-04
Call 2 — Left Voicemail
2022-05-07
Survey response — 6 months, dose 3
MedDRA: Emergency care, Flank pain, Hydronephrosis, Magnetic resonance imaging abnormal, Nephrolithiasis, Pre-existing disease — Feeling: Good · Be unable to work or attend school, 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, Emergency room or emergency department visit, Hospitalization

Free text: On April 11 I went to the ER with flank pain, an MRI indicated hydronephrosis from a 6.9mm kidney stone. I currently have a stent and will have another surgery on June 8 to break the stone up. I don't think it is covid or vaccine related.

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-08
Survey response — 12 months, dose 3
MedDRA: Nephrolithiasis, Renal stone removal — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: Not sure when I last checked in but in April I was diagnosed with a large kidney stone, it was subsequently removed.

MedDRA releases: 2024-11 · check-in free text available
2022-11-08
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-11-09
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	2021-03-15	Moderna
2	2021-04-12	Moderna
3	2021-11-06	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-02-05	Successful 2022-05-09	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-07	Successful 2022-05-09	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-08	Successful 2022-11-09	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Breast pain

2021-03-17

Systemic reaction (other): Last night after I had checked in I felt achy/chills, but I woke up today feeling fine.

Release 8 — day 21, dose 2

2021-05-03

Symptoms: When I started my menstrual cycle last Wednesday 4/28/2021 I had a horrible migraine that kept me bedridden most of the day. Pain and dizziness with sensitivity to light and noise.

Release 11 — 3 months, dose 3

2022-02-05

Symptoms: I contracted covid

Release 11 — 6 months, dose 3

2022-05-07

Symptoms: On April 11 I went to the ER with flank pain, an MRI indicated hydronephrosis from a 6.9mm kidney stone. I currently have a stent and will have another surgery on June 8 to break the stone up. I don't think it is covid or vaccine related.

Release 12 — 12 months, dose 3

2022-11-08

Symptoms: Not sure when I last checked in but in April I was diagnosed with a large kidney stone, it was subsequently removed.

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	Bedridden	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Emergency care	·	·	✓
SD	Flank pain	·	·	✓
SD	Hydronephrosis	·	·	✓
SD	Magnetic resonance imaging abnormal	·	·	✓
SD	Migraine	✓	✓	✓
SD	Nephrolithiasis	·	·	✓
SD	Pain	✓	✓	✓
SD	Photophobia	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Renal stone removal	·	·	✓
SRO	Breast pain	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Pain	✓	✓	✓

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