YW5-10728-55746

5 vaccinations 6 coded responses 20 check-ins 5 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 970 / OR
Registered: 2021-03-25

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

2021-02-26
Dose 1 — Moderna
2021-03-25
Registered in v-safe
2021-03-26
Dose 2 — Moderna
2021-03-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches · Be unable to work

Adult check-in
2021-04-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-17
Dose 3 — Moderna
2022-03-26
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-23
Dose 4 — Pfizer-BioNTech
2022-06-22
Survey response — day 28, dose 4
MedDRA: Cough, Lymphadenopathy, Nasal congestion, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Swollen glands, cough, stuffy nose, runny nose

MedDRA releases: 2024-11 · check-in free text available
2022-06-27
Survey response — day 35, dose 4
MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tested positive for Covid. This is day 10.

MedDRA releases: 2024-11 · check-in free text available
2022-07-04
Survey response — day 42, dose 4
MedDRA: Asthenia, Body temperature decreased, Body temperature fluctuation, COVID-19, Hypersomnia, Lethargy, Lymphadenopathy, Rhinorrhoea — Feeling: Fair · 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: Positive for Covid. Starting third week of sleeping 12 hours a night and Awakening extremely lethargic and weak. Also have bodily temperatures that fluctuate one as low as 94.8 up to 97.2. up and down mult time day and night. Swollen glands. Runny no

MedDRA releases: 2024-11 · check-in free text available
2022-07-04
Report sent to call center — day 42, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-22
Survey response — 3 months, dose 4
MedDRA: Asthenia, Body temperature fluctuation, Fatigue, Hypersomnia, Skin disorder — Feeling: Poor · Be unable to do your normal daily activities

Free text: Severe body temperature fluctuations, fatigue, unusual skin conditions, sleeping 12 hours every night. Weak.

MedDRA releases: 2024-11 · check-in free text available
2022-10-31
Dose 5 — Pfizer-BioNTech
2022-11-21
Survey response — 6 months, dose 4
MedDRA: Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities

Free text: Gall Bladder

MedDRA releases: 2024-11 · check-in free text available
2023-05-01
Survey response — 6 months, dose 5
MedDRA: Office visit, Oral lichen planus, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-01
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2023-05-02
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	2021-02-26	Moderna
2	2021-03-26	Moderna
3	2021-11-17	Moderna	No
4	2022-05-23	Pfizer-BioNTech	No
5	2022-10-31	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-07-04	Successful 2022-07-05	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-05-01	Successful 2023-05-02	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 12 — day 28, dose 4

2022-06-22

Symptoms: Swollen glands, cough, stuffy nose, runny nose

Release 12 — day 35, dose 4

2022-06-27

Symptoms: Tested positive for Covid. This is day 10.

Release 12 — day 42, dose 4

2022-07-04

Symptoms: Positive for Covid. Starting third week of sleeping 12 hours a night and Awakening extremely lethargic and weak. Also have bodily temperatures that fluctuate one as low as 94.8 up to 97.2. up and down mult time day and night. Swollen glands. Runny no cut off by CDC

Release 12 — 3 months, dose 4

2022-08-22

Symptoms: Severe body temperature fluctuations, fatigue, unusual skin conditions, sleeping 12 hours every night. Weak.

Release 12 — 6 months, dose 4

2022-11-21

Symptoms: Gall Bladder

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	Oral lichen planus	·	·	✓
SD	Asthenia	·	·	✓
SD	Body temperature decreased	·	·	✓
SD	Body temperature fluctuation	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypersomnia	·	·	✓
SD	Lethargy	·	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Oral lichen planus	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Skin disorder	·	·	✓
SD	Unevaluable event	·	·	✓

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