Y9N-10253-28882

3 vaccinations 7 coded responses 36 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 461 / IN
Registered: 2021-02-11

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

2021-02-11
Registered in v-safe
2021-02-11
Dose 1 — Moderna
2021-02-11
Health check-in — day 0, dose 1
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-18
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 21, dose 1
MedDRA: Hypersensitivity — Feeling: Fair

Free text: Allergy symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 28, dose 1
MedDRA: Cough, Office visit, Respiratory tract congestion, SARS-CoV-2 test negative, Telemedicine — Feeling: Poor · 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: Symptoms: Cough , and congestion. Covid test 3/9/21 was negative. · Healthcare visit (other): Telemetry and Dr visit 3/11/2021

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-15
Dose 2 — Moderna
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-03-21
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Redness, Itching · Joint pains, Fatigue or tiredness

Free text: These questions started way too late. My second shot was March 15 and I had several side effects to report Lasted more than 72 hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-16
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-28
Dose 3 — Pfizer-BioNTech
2021-10-28
Survey response — day 0, dose 3
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Burning feeling near injection site

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Eyelid ptosis — Feeling: Fair · Site: Pain, Redness · Fever · Headache, Joint pains

Free text: My left eye did not open all the way yesterday , today it's open all the way

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness · Joint pains, Fatigue or tiredness, Diarrhea

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Good · Site: Pain

Free text: Some tiredness

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — day 7, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-02-27
Call successful
Participant prefers to complete VAERS report online
2022-04-28
Health check-in — 6 months, dose 3
Feeling: Poor

Adult check-in
2022-10-28
Survey response — 12 months, dose 3
MedDRA: Bronchitis, COVID-19, Pneumonia — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Cvid diagnosis Bronchitis May - mid June then Double pneumonia in Aug-mid September.

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-31
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	2021-02-11	Moderna
2	2021-03-15	Moderna
3	2021-10-28	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-11	Successful 2022-02-27	Participant prefers to complete VAERS report online
2022-10-28	Successful 2022-10-31	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — day 21, dose 1

2021-03-04

Symptoms: Allergy symptoms

Release 5 — day 28, dose 1

2021-03-11

Symptoms: Cough , and congestion. Covid test 3/9/21 was negative.

Healthcare visit (other): Telemetry and Dr visit 3/11/2021

Release 6 — days 1–6 daily, dose 2

2021-03-21

Systemic reaction (other): These questions started way too late. My second shot was March 15 and I had several side effects to report Lasted more than 72 hours

Release 10 — day 0, dose 3

2021-10-28

Systemic reaction (other): Burning feeling near injection site

Release 10 — days 1–6 daily, dose 3

2021-10-30

Systemic reaction (other): My left eye did not open all the way yesterday , today it's open all the way

2021-11-02

Systemic reaction (other): Some tiredness

Release 12 — 12 months, dose 3

2022-10-28

Symptoms: Cvid diagnosis Bronchitis May - mid June then Double pneumonia in Aug-mid September.

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	✓	✓	✓
HCVO	Telemedicine	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	Cough	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Pneumonia	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Eyelid ptosis	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Injection site pain	·	·	✓

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