YV3-23061-04080

5 vaccinations 15 coded responses 69 check-ins 14 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 275 / NC
Registered: 2021-05-07

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

2021-05-07
Registered in v-safe
2021-05-07
Dose 1 — Moderna
2021-05-07
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-05-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-28
Survey response — day 21, dose 1
MedDRA: Blood glucose abnormal, Hospitalisation, Pallor — Feeling: Fair

Free text: Today, my low blood sugar caused me to turn pale in color in my face, arms and hands and feeling like I was going to pass out. I was at a hospital and in the recovery room with my boyfriend who had just had surgery. The nurses started helping me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Dose 2 — Moderna
2021-06-04
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-06-05
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Influenza like illness — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loss of appetite. I feel like I have the flu.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-06
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness, Nausea

Adult check-in
2021-06-08
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Just the muscle near the injection site aches a little.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-11
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-06-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-25
Survey response — day 21, dose 2
MedDRA: Balance disorder, Pre-existing disease, Visual impairment — Feeling: Fair

Free text: Vision is not right since I left Walmart about 11:45am. Feel off balance slightly, I can tell it when I stand. Hard to explain. Don't know if it's issues with my anxiety disorder or my mitral valve prolapse. I had a wave feeling go through me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-09
Survey response — day 35, dose 2
MedDRA: Fatigue, Vertigo — Feeling: Fair

Free text: Vertigo and fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-09-03
Survey response — 3 months, dose 2
MedDRA: Vertigo — Feeling: Fair

Free text: Vertigo

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-12-03
Survey response — 6 months, dose 2
MedDRA: Asthenia, Fatigue, Headache, Nausea — Feeling: Fair · Be unable to do your normal daily activities

Free text: More tired than normal, feel weak, nauseous a lot, headaches on and off

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Dose 3 — Moderna
2021-12-04
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · None

Adult check-in
2021-12-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-12-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-12-08
Survey response — days 1–6 daily, dose 3
MedDRA: Malaise, Office visit — Feeling: Fair · Fatigue or tiredness, Nausea · Get care from a doctor or other healthcare professional

Free text: Went to my doctor's office, but because of being sick since day after Thanksgiving

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-12-11
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-12-18
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-08
Survey response — day 35, dose 3
MedDRA: Cough, Dysphonia, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Cough, sore throat, runny and stuffy nose, hoarse voice - cold symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-01-08
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-11
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-15
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-06-24
Dose 4 — Pfizer-BioNTech
2022-06-24
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-06-25
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2022-06-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2022-06-27
Survey response — days 1–6 daily, dose 4
MedDRA: Cough, Throat irritation — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cough, scratchy throat

MedDRA releases: 2024-11 · check-in free text available
2022-06-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Nausea

Adult check-in
2022-06-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2022-06-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-02
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-07-08
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-07-15
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-22
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-07-31
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-08-05
Survey response — day 42, dose 4
MedDRA: Asthenia, Balance disorder, Nausea — Feeling: Good

Free text: Nauseated, off balance, weakness

MedDRA releases: 2024-11 · check-in free text available
2022-09-26
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-02
Dose 5 — Pfizer-BioNTech
2022-10-02
Health check-in — day 0, dose 5
Feeling: Good · None

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

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

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

Adult check-in
2022-10-06
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-10-07
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-08
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-09
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-16
Survey response — day 14, dose 5
MedDRA: Abdominal pain lower, Chills, Headache, Nausea, Pain, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fever, body aches, headaches, chills, lower abdominal pain, nausea.

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Survey response — day 21, dose 5
MedDRA: Abdominal distension, Abdominal pain, Flushing, Nausea — Feeling: Fair

Free text: Abdominal pain, bloated, flush, nausea at times

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-11-06
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-13
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-01
Survey response — 3 months, dose 5
MedDRA: Fatigue, Loss of personal independence in daily activities — Feeling: Fair

MedDRA releases: 2024-11
2023-04-04
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-07	Moderna
2	2021-06-04	Moderna
3	2021-12-04	Moderna	No
4	2022-06-24	Pfizer-BioNTech	No
5	2022-10-02	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-08	Successful 2021-12-09	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-08	Successful 2022-01-11	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 8 — day 21, dose 1

2021-05-28

Symptoms: Today, my low blood sugar caused me to turn pale in color in my face, arms and hands and feeling like I was going to pass out. I was at a hospital and in the recovery room with my boyfriend who had just had surgery. The nurses started helping me.

Release 8 — days 1–6 daily, dose 2

2021-06-05

Systemic reaction (other): Loss of appetite. I feel like I have the flu.

2021-06-06

Systemic reaction (other): Weakness

2021-06-08

Systemic reaction (other): Just the muscle near the injection site aches a little.

Release 9 — day 21, dose 2

2021-06-25

Symptoms: Vision is not right since I left Walmart about 11:45am. Feel off balance slightly, I can tell it when I stand. Hard to explain. Don't know if it's issues with my anxiety disorder or my mitral valve prolapse. I had a wave feeling go through me.

Release 9 — day 35, dose 2

2021-07-09

Symptoms: Vertigo and fatigue

Release 9 — 3 months, dose 2

2021-09-03

Symptoms: Vertigo

Release 10 — 6 months, dose 2

2021-12-03

Symptoms: More tired than normal, feel weak, nauseous a lot, headaches on and off

Release 10 — days 1–6 daily, dose 3

2021-12-08

Healthcare visit (other): Went to my doctor's office, but because of being sick since day after Thanksgiving

Release 10 — day 35, dose 3

2022-01-08

Symptoms: Cough, sore throat, runny and stuffy nose, hoarse voice - cold symptoms

Release 12 — days 1–6 daily, dose 4

2022-06-27

Systemic reaction (other): Cough, scratchy throat

Release 12 — day 42, dose 4

2022-08-05

Symptoms: Nauseated, off balance, weakness

Release 12 — day 14, dose 5

2022-10-16

Symptoms: Fever, body aches, headaches, chills, lower abdominal pain, nausea.

Release 12 — day 21, dose 5

2022-10-23

Symptoms: Abdominal pain, bloated, flush, nausea at times

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	Malaise	·	·	✓
HCVO	Office visit	·	·	✓
SD	Abdominal distension	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Abdominal pain lower	·	·	✓
SD	Asthenia	·	·	✓
SD	Balance disorder	✓	✓	✓
SD	Blood glucose abnormal	✓	✓	✓
SD	Chills	·	·	✓
SD	Cough	·	·	✓
SD	Dysphonia	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Flushing	·	·	✓
SD	Headache	·	·	✓
SD	Hospitalisation	✓	✓	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pallor	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Vertigo	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Influenza like illness	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Throat irritation	·	·	✓

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