YVQ-31070-45577

3 vaccinations 5 coded responses 36 check-ins 5 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 161 / PA
Registered: 2021-01-27

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

5XA-43736-70569 Child or adolescent in my care · Male · 2021-11-06

MKE-89175-75863 Child or adolescent in my care · Female · 2021-11-07

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-26
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-09
Survey response — day 14, dose 1
MedDRA: Injection site pruritus, Injection site rash, Injection site warmth, Self-medication — Feeling: Good

Free text: Large red rash on vaccine site, itchy and hot, lasted from 2/3-2/5, required Benadryl for two days then went away

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-23
Dose 2 — Moderna
2021-02-23
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-02
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Survey response — day 14, dose 3
MedDRA: Headache, Myalgia, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities

Free text: Muscle aches and headaches. I went and got Covid tested just in case but tested negative. My son was also sick.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — day 21, dose 3
MedDRA: Headache, Myalgia — Feeling: Good

Free text: Muscle aches, headaches

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-25
Survey response — 6 months, dose 3
MedDRA: Headache, Paranasal sinus discomfort, Respiratory tract congestion, Sinusitis — 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 · Telehealth, virtual health, or email health consultation

Free text: Sinus infection- headache, congestion, sinus pressure

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — 6 months, dose 3
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 · 1 call case(s)
2022-04-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-25
Survey response — 12 months, dose 3
MedDRA: COVID-19, SARS-CoV-2 test positive — 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 · Telehealth, virtual health, or email health consultation

Free text: Covid on 7/29, tested positive for 11 days

MedDRA releases: 2024-11 · check-in free text available
2022-10-25
Report sent to call center — 12 months, dose 3
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 · 1 call case(s)
2022-10-26
Call 1 — Left Voicemail
2022-10-26
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-23	Moderna
3	2021-10-25	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-25	Successful 2022-04-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-25	Successful 2022-10-26	Participant prefers to complete VAERS report online

Free text

Release 3 — day 14, dose 1

2021-02-09

Symptoms: Large red rash on vaccine site, itchy and hot, lasted from 2/3-2/5, required Benadryl for two days then went away

Release 10 — day 14, dose 3

2021-11-08

Symptoms: Muscle aches and headaches. I went and got Covid tested just in case but tested negative. My son was also sick.

Release 10 — day 21, dose 3

2021-11-15

Symptoms: Muscle aches, headaches

Release 11 — 6 months, dose 3

2022-04-25

Symptoms: Sinus infection- headache, congestion, sinus pressure

Release 12 — 12 months, dose 3

2022-10-25

Symptoms: Covid on 7/29, tested positive for 11 days

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
SD	COVID-19	·	·	✓
SD	Headache	·	·	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Self-medication	✓	✓	✓
SD	Sinusitis	·	·	✓

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