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YW6-27982-10808

5 vaccinations 15 coded responses 41 check-ins 15 free-text entries 1 call case
Sex
Female
Age at first dose
66+
ZIP prefix
941 / CA
Registered
2021-01-23
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-22
    Dose 1 — Moderna
  2. 2021-01-23
    Registered in v-safe
  3. 2021-01-25
    Survey response — days 1–6 daily, dose 1
    MedDRA: Insomnia — Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness
    Free text: Difficulties falling asleep (is unusual)
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-01-26
    Survey response — days 1–6 daily, dose 1
    MedDRA: Fatigue, Rash, Rash pruritic, Vibratory sense increased — Feeling: Fair · Chills, Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities
    Free text: Vibration Sensation in lateral aspect of left front foot, then pain in lateral thigh/hip on Same side. Itchy frontal and periorbital rash. Overwhelming fatigue
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-27
    Survey response — days 1–6 daily, dose 1
    MedDRA: Adverse reaction — Feeling: Good · Site: Itching · Fatigue or tiredness
    Free text: Much improved
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-28
    Survey response — days 1–6 daily, dose 1
    MedDRA: Unevaluable event — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site
    Free text: Mich improved, but now have elevated (symptomatic)systolic blood pressure
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-01-29
    Health check-in — day 7, dose 1
    Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site
    Adult check-in
  8. 2021-02-05
    Survey response — day 14, dose 1
    MedDRA: Injection site erythema, Injection site swelling, Injection site warmth — Feeling: Good
    Free text: 7 days after the vaccination, i.e. 01/29, the vaccination site was suddenly red, hot, and swollen - had been completely calm before that. Resolved slowly over the next two days, all gone the third day, no accompanying symptoms.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-02-12
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-02-19
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-02-25
    Dose 2 — Moderna
  12. 2021-02-25
    Survey response — day 0, dose 2
    MedDRA: No adverse event — Feeling: Good · Headache
    Free text: No
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-02-26
    Survey response — days 1–6 daily, dose 2
    MedDRA: Balance disorder, Dizziness — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities
    Free text: Inability to be vertical. Wobbly on my feet, mild balance problems
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-02-27
    Survey response — days 1–6 daily, dose 2
    MedDRA: Night sweats — Feeling: Good · Fatigue or tiredness, Nausea
    Free text: Night sweats last night, but nothing else anymore
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-02-28
    Survey response — days 1–6 daily, dose 2
    MedDRA: Night sweats — Feeling: Good · Fatigue or tiredness, Nausea
    Free text: Night sweats resolved; none last noght
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-03-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · Fatigue or tiredness
    Adult check-in
  17. 2021-03-02
    Survey response — days 1–6 daily, dose 2
    MedDRA: Gait disturbance — Feeling: Good · Fatigue or tiredness
    Free text: I perceive a slightly wobbly gait, nothing serious. Also occurred a few days after the first inoculation. No one else observes me as wobbly.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-03-03
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache
    Adult check-in
  19. 2021-03-04
    Survey response — day 7, dose 2
    MedDRA: Headache — Feeling: Good · Headache
    Free text: Headache is intermittent
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-03-12
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-03-20
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-03-25
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-04-01
    Survey response — day 35, dose 2
    MedDRA: Pre-existing disease — Feeling: Good
    Free text: Seasonal allergy
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  24. 2021-04-08
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-28
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-08-26
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-09-13
    Dose 3 — Moderna
  28. 2021-10-25
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  29. 2021-12-13
    Health check-in — 3 months, dose 3
    Feeling: Fair
    Adult check-in
  30. 2022-03-14
    Survey response — 6 months, dose 3
    MedDRA: Back pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Low right-sided back pain for 5 1/2 months!
    MedDRA releases: 2024-11 · check-in free text available
  31. 2022-03-14
    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 · 1 call case(s)
  32. 2022-03-16
  33. 2022-03-16
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  34. 2022-03-21
    Dose 4 — Moderna
  35. 2022-04-14
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  36. 2022-04-18
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  37. 2022-04-25
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  38. 2022-05-02
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  39. 2022-06-20
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  40. 2022-09-20
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  41. 2022-09-22
    Dose 5 — Pfizer-BioNTech
  42. 2022-09-28
    Survey response — days 1–6 daily, dose 5
    MedDRA: Unevaluable event — Feeling: Good · Site: Pain, Redness, Swelling
    Free text: Nothing having to do with vaccination
    MedDRA releases: 2024-11 · check-in free text available
  43. 2022-09-29
    Health check-in — day 7, dose 5
    Feeling: Fair · Site: Redness · Headache, Muscle or body aches
    Adult check-in
  44. 2022-10-07
    Health check-in — day 14, dose 5
    Feeling: Good
    Adult check-in
  45. 2022-10-13
    Health check-in — day 21, dose 5
    Feeling: Good
    Adult check-in
  46. 2022-10-22
    Health check-in — day 28, dose 5
    Feeling: Good
    Adult check-in
  47. 2022-10-28
    Survey response — day 35, dose 5
    MedDRA: Blood pressure systolic increased — Feeling: Good
    Free text: Volatil systolic blood pressure, high
    MedDRA releases: 2024-11 · check-in free text available
  48. 2022-11-05
    Health check-in — day 42, dose 5
    Feeling: Good
    Adult check-in
  49. 2022-12-22
    Health check-in — 3 months, dose 5
    Feeling: Good
    Adult check-in
  50. 2023-03-23
    Health check-in — 6 months, dose 5
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-22Moderna
22021-02-25Moderna
32021-09-13Moderna No
42022-03-21Moderna No
52022-09-22Pfizer-BioNTech No

Call center

ReportedOutcomeVAERS-related outcome
2022-03-14 Successful
2022-03-16
 Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-25

Systemic reaction (other): Difficulties falling asleep (is unusual)

2021-01-26

Systemic reaction (other): Vibration Sensation in lateral aspect of left front foot, then pain in lateral thigh/hip on Same side. Itchy frontal and periorbital rash. Overwhelming fatigue

2021-01-27

Systemic reaction (other): Much improved

2021-01-28

Systemic reaction (other): Mich improved, but now have elevated (symptomatic)systolic blood pressure

Release 3 — day 14, dose 1

2021-02-05

Symptoms: 7 days after the vaccination, i.e. 01/29, the vaccination site was suddenly red, hot, and swollen - had been completely calm before that. Resolved slowly over the next two days, all gone the third day, no accompanying symptoms.

Release 4 — day 0, dose 2

2021-02-25

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): Inability to be vertical. Wobbly on my feet, mild balance problems

2021-02-27

Systemic reaction (other): Night sweats last night, but nothing else anymore

2021-02-28

Systemic reaction (other): Night sweats resolved; none last noght

2021-03-02

Systemic reaction (other): I perceive a slightly wobbly gait, nothing serious. Also occurred a few days after the first inoculation. No one else observes me as wobbly.

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): Headache is intermittent

Release 6 — day 35, dose 2

2021-04-01

Symptoms: Seasonal allergy

Release 11 — 6 months, dose 3

2022-03-14

Symptoms: Low right-sided back pain for 5 1/2 months!

Release 12 — days 1–6 daily, dose 5

2022-09-28

Systemic reaction (other): Nothing having to do with vaccination

Release 12 — day 35, dose 5

2022-10-28

Symptoms: Volatil systolic blood pressure, high

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

FieldPreferred term2021-092023-042024-11
SDBack pain · · ✓
SDBlood pressure systolic increased · · ✓
SDInjection site erythema ✓ ✓ ✓
SDInjection site swelling ✓ ✓ ✓
SDInjection site warmth ✓ ✓ ✓
SDPre-existing disease ✓ ✓ ✓
SROAdverse reaction ✓ ✓ ✓
SROBalance disorder ✓ ✓ ✓
SRODizziness ✓ ✓ ✓
SROFatigue ✓ ✓ ✓
SROGait disturbance ✓ ✓ ✓
SROHeadache ✓ ✓ ✓
SROInsomnia ✓ ✓ ✓
SRONight sweats ✓ ✓ ✓
SRONo adverse event ✓ ✓ ✓
SRORash ✓ ✓ ✓
SRORash pruritic ✓ ✓ ✓
SROUnevaluable event ✓ ✓ ✓
SROVibratory sense increased ✓ ✓ ✓

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

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