YL7-26057-32305

3 vaccinations 16 coded responses 38 check-ins 16 free-text entries 7 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 523 / IA
Registered: 2021-01-13

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

2021-01-13
Registered in v-safe
2021-01-13
Dose 1 — Moderna
2021-01-13
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Headache

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

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Survey response — day 14, dose 1
MedDRA: COVID-19 pneumonia — Feeling: Poor · Be unable to work, 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

Free text: Developed covid from high risk exposure and bilateral pneumonia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 14, dose 1
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 · 1 call case(s)
2021-02-03
Survey response — day 21, dose 1
MedDRA: COVID-19, Chest pain, Dyspnoea, Pneumonia — Feeling: Fair · Be unable to work, 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

Free text: Shortness of breath and chest pain; lingering effects of covid and pneumonia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Report sent to call center — day 21, dose 1
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)
2021-02-10
Dose 2 — Moderna
2021-02-10
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Had COVID 21 days ago; with this vaccine my cough and chest pain returned

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Paranasal sinus discomfort, Rhinorrhoea — Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Runny nose and intense sinus pressure began today; mild cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Dyspnoea, Rhinorrhoea, Sinus pain, Telemedicine — Feeling: Poor · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · 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: Systemic reaction (other): Shortness of breath, cough, runny nose, sinus pain; spoke with doctor who thinks my recent covid infection may have been reactivated but cannot test as soon Id still be positive from my recent infection · Healthcare visit (other): Telehealth covid clinic

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
Be unable to do your normal daily activities · 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: Cough, Dyspnoea, Rhinorrhoea, Sinus pain — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sinus pain, runny nose, shortness of breath and cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Nasopharyngitis, Respiratory tract congestion, Rhinorrhoea — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Mild cold like symptoms- runny nose, congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-17
Survey response — day 7, dose 2
MedDRA: Respiratory tract congestion, Rhinorrhoea, Sinus pain — Feeling: Fair · Fatigue or tiredness

Free text: Still have sinus pain, congestion and slight runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-01
Call successful
Participant prefers to complete VAERS report online
2021-03-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-10
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · 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: Symptoms: Developed fractured cardiac pacemaker lead (atrial), requiring replacement on 3/8/21 · Healthcare visit (other): Procedures on 3/5/21 (venogram) and 3/8/21 (pacemaker lead and generator replacement)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — day 28, 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)
2021-03-17
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-24
Survey response — day 42, dose 2
MedDRA: Heart rate increased — Feeling: Fair · Be unable to do your normal daily activities

Free text: Doubtful its related to the vaccine but Ive been having runs of high heart rate (140s) with little activity

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Pregnancy registry survey
Not pregnant at or since vaccination ·
2021-05-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Call 1 — Could Not Reach Participant
2021-08-03
Call 2 — Left Voicemail
2021-08-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-20
Dose 3 — Moderna
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-11-23
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Swollen lymph nodes in neck

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-26
Survey response — days 1–6 daily, dose 3
MedDRA: Nasopharyngitis, Rhinorrhoea, Sinus pain — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Sinus pain, runny nose- cold-like symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — day 7, dose 3
MedDRA: Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Runny nose, congestion (Covid test was negative)

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Survey response — day 14, dose 3
MedDRA: Asthma, Bronchitis, Nasopharyngitis, Pre-existing disease — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bronchitis and moderate asthma flare due to cold

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Report sent to call center — day 14, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-06
Call successful
Not applicable - Accidental Reporting
2021-12-06
Call successful
Not applicable - Accidental Reporting
2021-12-06
Call successful
Not applicable - Accidental Reporting
2021-12-11
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-18
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-01
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-19
Survey response — 3 months, dose 3
MedDRA: Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus infection (not related to the vaccine)

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-22
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-21
Survey response — 6 months, dose 3
MedDRA: Asthma, Bronchitis, Pre-existing disease — Feeling: Fair · 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: Bronchitis, asthma flare (unrelated to vaccine and is not COVID)

MedDRA releases: 2024-11 · check-in free text available
2022-05-21
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-23
Call 1 — Could Not Reach Participant
2022-05-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-22
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-11-30
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna
2	2021-02-10	Moderna
3	2021-11-20	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-27	Unsuccessful
2021-02-03	Successful 2021-03-01	Participant prefers to complete VAERS report online
2021-02-13	Successful 2021-12-06	Not applicable - Accidental Reporting
2021-03-10	Successful 2021-12-06	Not applicable - Accidental Reporting
2021-12-04	Successful 2021-12-06	Not applicable - Accidental Reporting
2022-02-19	Successful 2022-02-22	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-21	Successful 2022-05-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 2 — day 14, dose 1

2021-01-27

Symptoms: Developed covid from high risk exposure and bilateral pneumonia

Release 3 — day 21, dose 1

2021-02-03

Symptoms: Shortness of breath and chest pain; lingering effects of covid and pneumonia

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): Had COVID 21 days ago; with this vaccine my cough and chest pain returned

2021-02-12

Systemic reaction (other): Runny nose and intense sinus pressure began today; mild cough

2021-02-13

Systemic reaction (other): Shortness of breath, cough, runny nose, sinus pain; spoke with doctor who thinks my recent covid infection may have been reactivated but cannot test as soon Id still be positive from my recent infection

Healthcare visit (other): Telehealth covid clinic

2021-02-14

Systemic reaction (other): Sinus pain, runny nose, shortness of breath and cough

2021-02-15

Systemic reaction (other): Mild cold like symptoms- runny nose, congestion

Release 4 — day 7, dose 2

2021-02-17

Systemic reaction (other): Still have sinus pain, congestion and slight runny nose

Release 5 — day 28, dose 2

2021-03-10

Symptoms: Developed fractured cardiac pacemaker lead (atrial), requiring replacement on 3/8/21

Healthcare visit (other): Procedures on 3/5/21 (venogram) and 3/8/21 (pacemaker lead and generator replacement)

Release 6 — day 42, dose 2

2021-03-24

Symptoms: Doubtful its related to the vaccine but Ive been having runs of high heart rate (140s) with little activity

Release 10 — days 1–6 daily, dose 3

2021-11-23

Systemic reaction (other): Swollen lymph nodes in neck

2021-11-26

Systemic reaction (other): Sinus pain, runny nose- cold-like symptoms

Release 10 — day 7, dose 3

2021-11-27

Systemic reaction (other): Runny nose, congestion (Covid test was negative)

Release 10 — day 14, dose 3

2021-12-04

Symptoms: Bronchitis and moderate asthma flare due to cold

Release 11 — 3 months, dose 3

2022-02-19

Symptoms: Sinus infection (not related to the vaccine)

Release 11 — 6 months, dose 3

2022-05-21

Symptoms: Bronchitis, asthma flare (unrelated to vaccine and is not 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	Pre-existing disease	✓	✓	✓
HCVO	Telemedicine	✓	✓	✓
SD	Asthma	·	·	✓
SD	Bronchitis	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	COVID-19	✓	✓	✓
SD	COVID-19 pneumonia	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Pneumonia	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinusitis	·	·	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Paranasal sinus discomfort	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	SARS-CoV-2 test negative	·	·	✓
SRO	Sinus pain	✓	✓	✓

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