Y9H-23070-20138

2 vaccinations 7 coded responses 21 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 446 / OH
Registered: 2020-12-23

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

2020-12-23
Registered in v-safe
2020-12-23
Dose 1 — Moderna
2020-12-23
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Good · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2021-01-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-20
Dose 2 — Moderna
2021-01-21
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Tremor — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Shaking, weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-24
Survey response — days 1–6 daily, dose 2
MedDRA: Petechiae — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Petechiae, very small. Started yesterday afternoon.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — days 1–6 daily, dose 2
MedDRA: Syncope — Feeling: Fair · Site: Itching · Headache, Rash, not including the immediate area around the injection site

Free text: Fading and very faintly noted

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — day 7, dose 2
MedDRA: Petechiae — Feeling: Good · Headache

Free text: Petechiae faded. Platelet lab is normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-21
Survey response — 3 months, dose 2
MedDRA: Malaise — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Multiple Covid like symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Report sent to call center — 3 months, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-21
Survey response — 6 months, dose 2
MedDRA: Back pain, Cough, Office visit, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Sore throat, cough, fever 102, back ache. PCR and rapid COVID19 test both negative · Healthcare visit (other): and an Office visit

MedDRA releases: 2024-11 · check-in free text available
2021-07-21
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-20
Survey response — 12 months, dose 2
MedDRA: Body temperature increased, Cough, Fatigue, Retching, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school

Free text: Cough to point of getting gaggy, runny nose, slight elevation of temp 99.2(normal for me is 97.7) Tired. Two Rapid test negative for Covid.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-01-20	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-21	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-07-21	Successful 2021-07-24	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 2

2021-01-21

Systemic reaction (other): Shaking, weakness

2021-01-24

Systemic reaction (other): Petechiae, very small. Started yesterday afternoon.

2021-01-26

Systemic reaction (other): Fading and very faintly noted

Release 2 — day 7, dose 2

2021-01-27

Systemic reaction (other): Petechiae faded. Platelet lab is normal.

Release 7 — 3 months, dose 2

2021-04-21

Symptoms: Multiple Covid like symptoms

Release 9 — 6 months, dose 2

2021-07-21

Symptoms: Sore throat, cough, fever 102, back ache. PCR and rapid COVID19 test both negative

Healthcare visit (other): and an Office visit

Release 10 — 12 months, dose 2

2022-01-20

Symptoms: Cough to point of getting gaggy, runny nose, slight elevation of temp 99.2(normal for me is 97.7) Tired. Two Rapid test negative for Covid.

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	Back pain	·	·	✓
SD	Body temperature increased	·	·	✓
SD	Cough	·	·	✓
SD	Fatigue	·	·	✓
SD	Malaise	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Retching	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Petechiae	✓	✓	✓
SRO	Syncope	✓	✓	✓
SRO	Tremor	✓	✓	✓

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