Y7A-16682-87453

4 vaccinations 11 coded responses 32 check-ins 11 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 490 / MI
Registered: 2021-01-17

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

2021-01-11
Dose 1 — Moderna
2021-01-17
Registered in v-safe
2021-01-18
Survey response — day 7, dose 1
MedDRA: Nausea, Vertigo — Feeling: Good

Free text: A little vertigo and slight nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-08
Dose 2 — Moderna
2021-02-08
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Swelling, Itching · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Urinary tract infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Urinary tract infection. Havent had ine for 6 years

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Some minor symptoms of uti...on cipro

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Survey response — day 14, dose 2
MedDRA: Atrial fibrillation, Cardiac ablation, Cardioversion, Supraventricular tachycardia, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Having an ablation for SVT's and went into afib twice.heart needed to be shocked back into rythym twice. Unable to complete the ablation. This was exactly 2 weeks after my second vaccine. Dr saud that was a very unexpected response to the adreneline · Healthcare visit (other): scheduled operating room svt ablation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-03
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Very tired. Fatigue easily. 1 to 2 naps a day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — day 28, dose 2
MedDRA: Fatigue, Somnolence — Feeling: Fair

Free text: Very tired. Sleep 8 hours and haveto take naps in top of that. Otherwise feel fine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — day 35, dose 2
MedDRA: Abdominal pain lower, Abnormal faeces, Flatulence — Feeling: Fair

Free text: Gassy stomach. Lower left quadrant pain. Unusually gassy unpredictable stool

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — day 42, dose 2
MedDRA: Abdominal pain lower, Diverticulitis, Emergency care — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Was in ER 2 days ago severe lower left quadrant abdominal pain.dx: diverticulitus. Taking antibiotics. Liquid diet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-10
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Call 2 — Left Voicemail
2021-08-09
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-28
Dose 3 — Moderna
2022-02-08
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-28
Dose 4 — Pfizer-BioNTech
2022-04-29
Survey response — days 1–6 daily, dose 4
MedDRA: Dysgeusia, Fatigue — Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Free text: Metallic taste yesterday..tired yedtrrday

MedDRA releases: 2024-11 · check-in free text available
2022-05-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Swelling · None

Adult check-in
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-05
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-12
Health check-in — day 14, dose 4
Feeling: Good

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

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

Adult check-in
2022-06-02
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-09
Survey response — day 42, dose 4
MedDRA: Abdominal pain lower, Diverticulitis, Headache, Muscle spasms — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Cramping and liwer abdominal pain.headache. diverticulitus

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Report sent to call center — day 42, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-07-28
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-27
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-28
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-11	Moderna
2	2021-02-08	Moderna
3	2021-10-28	Moderna	No
4	2022-04-28	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-13	Unsuccessful
2021-02-14	Unsuccessful
2021-02-24	Unsuccessful
2021-03-22	Unsuccessful
2022-06-09	Unsuccessful

Free text

Release 2 — day 7, dose 1

2021-01-18

Systemic reaction (other): A little vertigo and slight nausea

Release 3 — days 1–6 daily, dose 2

2021-02-09

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Urinary tract infection. Havent had ine for 6 years

2021-02-14

Systemic reaction (other): Some minor symptoms of uti...on cipro

Release 4 — day 14, dose 2

2021-02-24

Symptoms: Having an ablation for SVT's and went into afib twice.heart needed to be shocked back into rythym twice. Unable to complete the ablation. This was exactly 2 weeks after my second vaccine. Dr saud that was a very unexpected response to the adreneline cut off by CDC

Healthcare visit (other): scheduled operating room svt ablation

Release 5 — day 21, dose 2

2021-03-03

Symptoms: Very tired. Fatigue easily. 1 to 2 naps a day.

Release 5 — day 28, dose 2

2021-03-08

Symptoms: Very tired. Sleep 8 hours and haveto take naps in top of that. Otherwise feel fine.

Release 5 — day 35, dose 2

2021-03-15

Symptoms: Gassy stomach. Lower left quadrant pain. Unusually gassy unpredictable stool

Release 6 — day 42, dose 2

2021-03-22

Symptoms: Was in ER 2 days ago severe lower left quadrant abdominal pain.dx: diverticulitus. Taking antibiotics. Liquid diet

Release 11 — days 1–6 daily, dose 4

2022-04-29

Systemic reaction (other): Metallic taste yesterday..tired yedtrrday

Release 12 — day 42, dose 4

2022-06-09

Symptoms: Cramping and liwer abdominal pain.headache. diverticulitus

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	Supraventricular tachycardia	○	✓	○
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal pain lower	✓	✓	✓
SD	Abnormal faeces	✓	✓	✓
SD	Atrial fibrillation	✓	✓	✓
SD	Cardiac ablation	✓	✓	✓
SD	Cardioversion	✓	✓	✓
SD	Diverticulitis	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Flatulence	✓	✓	✓
SD	Headache	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Somnolence	✓	✓	✓
SD	Supraventricular tachycardia	✓	✓	✓
SRO	Dysgeusia	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Nausea	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Urinary tract infection	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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