Y9C-44514-89391

3 vaccinations 10 coded responses 38 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 983 / WA
Registered: 2021-01-08

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-08
Registered in v-safe
2021-01-08
Dose 1 — Moderna
2021-01-08
Survey response — day 0, dose 1
MedDRA: Hypoaesthesia, Malaise, Peripheral coldness — Feeling: Good · Chills

Free text: Arm feels number from where the shot is at to my hand , feels cold. Just feel off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Free text: Mild shortness of breath, sore throat , runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills, Fatigue or tiredness

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · Fatigue or tiredness

Adult check-in
2021-01-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-05
Dose 2 — Moderna
2021-02-05
Survey response — day 0, dose 2
MedDRA: Brain fog, Dizziness, Feeling abnormal — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy, like in a fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain, Pain — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Neck pain (which could coincide with body aches)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · Joint pains, Muscle or body aches

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

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

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-12
Survey response — day 35, dose 2
MedDRA: Tinnitus, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Tinitus ringing of the ear but bothersome as it happens very often · Healthcare visit (other): Will be seeing my provider in 2 weeks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-06
Survey response — 6 months, dose 2
MedDRA: Angina pectoris — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Heart pain, and being checked for a blood clot . However not sure it may be related to the vaccine . There are many factors that can play into this such as lifestyle , type of work .

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-12
Call 1 — Left Voicemail
2021-08-16
Call 2 — Left Voicemail
2021-08-18
Call successful
Participant prefers to complete VAERS report online
2022-01-22
Dose 3 — Pfizer-BioNTech
2022-01-22
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2022-01-23
Survey response — days 1–6 daily, dose 3
MedDRA: Dissociation, Hyperhidrosis, Malaise — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Woke up soaked in sweat, feeling Malaise almost like I'm disassociated from myself

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-01-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-01-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-01-28
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease, Tinnitus — Feeling: Good

Free text: Tinnitus , off and on and longer than usual

MedDRA releases: 2024-11 · check-in free text available
2022-01-29
Survey response — day 7, dose 3
MedDRA: Tinnitus, Vaccine positive rechallenge — Feeling: Fair

Free text: Tinnitus. It's constant and I had this after the other shots but it came and go then stopped. After the booster it came back , was off and on but way more constant .not worried but it's annoying. Not sure it's directed w/ the booster but reporting

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-02-12
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-02-19
Survey response — day 28, dose 3
MedDRA: Tinnitus — Feeling: Good

Free text: Ringing of The ears comes and goes but is loud

MedDRA releases: 2024-11 · check-in free text available
2022-02-26
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-03-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-04-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-01-22
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-05	Moderna
3	2022-01-22	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-12	Successful	Participant prefers to complete VAERS report online
2021-08-06	Successful 2021-08-18	Participant prefers to complete VAERS report online

Free text

Release 1 — day 0, dose 1

2021-01-08

Systemic reaction (other): Arm feels number from where the shot is at to my hand , feels cold. Just feel off

Release 1 — days 1–6 daily, dose 1

2021-01-09

Systemic reaction (other): Mild shortness of breath, sore throat , runny nose

Release 3 — day 0, dose 2

2021-02-05

Systemic reaction (other): Dizzy, like in a fog

Release 3 — days 1–6 daily, dose 2

2021-02-06

Systemic reaction (other): Neck pain (which could coincide with body aches)

Release 5 — day 35, dose 2

2021-03-12

Symptoms: Tinitus ringing of the ear but bothersome as it happens very often

Healthcare visit (other): Will be seeing my provider in 2 weeks

Release 9 — 6 months, dose 2

2021-08-06

Symptoms: Heart pain, and being checked for a blood clot . However not sure it may be related to the vaccine . There are many factors that can play into this such as lifestyle , type of work .

Release 11 — days 1–6 daily, dose 3

2022-01-23

Systemic reaction (other): Woke up soaked in sweat, feeling Malaise almost like I'm disassociated from myself

2022-01-28

Systemic reaction (other): Tinnitus , off and on and longer than usual

Release 11 — day 7, dose 3

2022-01-29

Systemic reaction (other): Tinnitus. It's constant and I had this after the other shots but it came and go then stopped. After the booster it came back , was off and on but way more constant .not worried but it's annoying. Not sure it's directed w/ the booster but reporting

Release 11 — day 28, dose 3

2022-02-19

Symptoms: Ringing of The ears comes and goes but is loud

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	Unevaluable event	✓	✓	✓
SD	Angina pectoris	✓	·	✓
SD	Tinnitus	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Dissociation	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Feeling abnormal	✓	✓	○
SRO	Hyperhidrosis	·	·	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Peripheral coldness	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Tinnitus	·	·	✓
SRO	Vaccine positive rechallenge	·	·	✓

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