YLX-20952-44580

5 vaccinations 8 coded responses 48 check-ins 7 free-text entries 5 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 454 / OH
Registered: 2020-12-28

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
Dose 1 — Moderna
2020-12-28
Registered in v-safe
2020-12-28
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Headache — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: Had a headache and tiredness after the vaccination...I may have been dehydrated as I work full-time and don't always hydrate during the day. I work in healthcare as it is not unusual for me to be tired after working ! I am feeling fine today !

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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 · None

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

Adult check-in
2021-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-20
Dose 2 — Moderna
2021-01-27
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-03
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
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Dose 3 — Moderna
2021-09-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-09-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-09-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-09-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-09-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-09-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Fatigue or tiredness

Adult check-in
2021-09-10
Health check-in — day 7, dose 3
Feeling: Good · Site: Swelling · None

Adult check-in
2021-09-17
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-09-24
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-08
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-15
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-04
Survey response — 6 months, dose 3
MedDRA: Office visit, Supraventricular tachycardia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: SVT cardiac · Healthcare visit (other): Cardiology Consult to (b)(6) Clinic

MedDRA releases: 2024-11 · check-in free text available
2022-03-04
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
2022-03-11
Call 1 — Could Not Reach Participant
2022-03-14
Call 2 — Left Voicemail
2022-03-15
Call 3 — Left Voicemail
2022-04-01
Dose 4 — Moderna
2022-04-14
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-15
Survey response — day 14, dose 4
MedDRA: Office visit, Supraventricular tachycardia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Cardiac SVT · Healthcare visit (other): (b)(6) Clinic 05/11/2022

MedDRA releases: 2024-11 · check-in free text available
2022-04-15
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-21
Call 1 — Left Voicemail
2022-04-22
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-29
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-05-06
Survey response — day 35, dose 4
MedDRA: Palpitations, Supraventricular tachycardia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: SVT chest palpitations

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-09
Call successful
Participant prefers to complete VAERS report online
2022-05-09
Call successful
Participant prefers to complete VAERS report online
2022-05-09
Call successful
Participant prefers to complete VAERS report online
2022-05-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-03
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-30
Dose 5 — Moderna
2022-09-30
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2022-10-02
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Swelling · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-03
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-04
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-05
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-06
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · None

Adult check-in
2022-10-07
Health check-in — day 7, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-14
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-10-21
Survey response — day 21, dose 5
MedDRA: Breast pain — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Left breast pain

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Report sent to call center — day 21, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-24
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-28
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-11-04
Survey response — day 35, dose 5
MedDRA: Pre-existing disease — Feeling: Good

Free text: It is back issues of scoliosis

MedDRA releases: 2024-11 · check-in free text available
2022-11-11
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-30
Survey response — 3 months, dose 5
MedDRA: Fall, Head injury — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Sustained a fall in 11/24/2022?hit head on ground.

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2023-01-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-31
Survey response — 6 months, dose 5
MedDRA: Anxiety — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-01-20	Moderna
3	2021-09-03	Moderna	No
4	2022-04-01	Moderna	No
5	2022-09-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-04	Successful 2022-05-09	Participant prefers to complete VAERS report online
2022-04-15	Successful 2022-05-09	Participant prefers to complete VAERS report online
2022-05-06	Successful 2022-05-09	Participant prefers to complete VAERS report online
2022-10-21	Successful 2022-10-24	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-30	Successful 2023-01-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-28

Systemic reaction (other): Had a headache and tiredness after the vaccination...I may have been dehydrated as I work full-time and don't always hydrate during the day. I work in healthcare as it is not unusual for me to be tired after working ! I am feeling fine today !

Release 11 — 6 months, dose 3

2022-03-04

Symptoms: SVT cardiac

Healthcare visit (other): Cardiology Consult to (b)(6) Clinic

redacted (b)(6)

Release 11 — day 14, dose 4

2022-04-15

Symptoms: Cardiac SVT

Healthcare visit (other): (b)(6) Clinic 05/11/2022

redacted (b)(6)

Release 11 — day 35, dose 4

2022-05-06

Symptoms: SVT chest palpitations

Release 12 — day 21, dose 5

2022-10-21

Symptoms: Left breast pain

Release 12 — day 35, dose 5

2022-11-04

Symptoms: It is back issues of scoliosis

Release 12 — 3 months, dose 5

2022-12-30

Symptoms: Sustained a fall in 11/24/2022?hit head on ground.

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	Anxiety	·	·	✓
SD	Breast pain	·	·	✓
SD	Fall	·	·	✓
SD	Head injury	·	·	✓
SD	Palpitations	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Supraventricular tachycardia	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓

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