YW8-57327-01578

5 vaccinations 7 coded responses 56 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 559 / MN
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-04
Dose 1 — Moderna
2021-02-04
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-18
Survey response — day 14, dose 1
MedDRA: Headache, Oropharyngeal pain, SARS-CoV-2 test — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Sore throat, headache · Healthcare visit (other): Called nurse line and triaged regarding a covid-19 test and went in today for a PCR nasal swab test. Awaiting results.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-04
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Slight sore arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-06
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-10-29
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

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

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-12
Dose 4 — Moderna
2022-04-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2022-04-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-26
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-11
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-13
Dose 5 — Pfizer-BioNTech
2022-09-16
Survey response — days 1–6 daily, dose 5
MedDRA: Dizziness — Feeling: Fair · Headache

Free text: Dizzy

MedDRA releases: 2024-11 · check-in free text available
2022-09-17
Survey response — days 1–6 daily, dose 5
MedDRA: Dizziness — Feeling: Fair · Headache

Free text: Dizzy

MedDRA releases: 2024-11 · check-in free text available
2022-09-20
Survey response — day 7, dose 5
MedDRA: Dizziness — Feeling: Fair · Headache

Free text: Dizzy

MedDRA releases: 2024-11 · check-in free text available
2022-09-27
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-04
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-11
Survey response — day 28, dose 5
MedDRA: Dizziness, Emergency care, Head titubation, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Slight head tremors, dizziness and headache. Went to ER. MRI of head normal. Head tremors better. Dizziness and headaches continues. Chronic headaches are common for me. Will follow up with primary for dizziness.

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Report sent to call center — day 28, dose 5
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-10-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-18
Survey response — day 35, dose 5
MedDRA: Dizziness, Headache, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Dizziness and headaches continue. Went to a neurologist who said that the dizziness could be from covid booster. She will do further testing to rule out other things.

MedDRA releases: 2024-11 · check-in free text available
2022-10-18
Report sent to call center — day 35, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-19
Call 1 — Left Voicemail
2022-10-25
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-13
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-14
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2021-10-29	Moderna	No
4	2022-04-12	Moderna	No
5	2022-09-13	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-18	Successful 2021-08-06	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-11	Successful 2022-10-12	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-18	Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-02-18

Symptoms: Sore throat, headache

Healthcare visit (other): Called nurse line and triaged regarding a covid-19 test and went in today for a PCR nasal swab test. Awaiting results.

Release 5 — days 1–6 daily, dose 2

2021-03-05

Systemic reaction (other): Slight sore arm

Release 12 — days 1–6 daily, dose 5

2022-09-16

Systemic reaction (other): Dizzy

2022-09-17

Systemic reaction (other): Dizzy

Release 12 — day 7, dose 5

2022-09-20

Systemic reaction (other): Dizzy

Release 12 — day 28, dose 5

2022-10-11

Symptoms: Slight head tremors, dizziness and headache. Went to ER. MRI of head normal. Head tremors better. Dizziness and headaches continues. Chronic headaches are common for me. Will follow up with primary for dizziness.

Release 12 — day 35, dose 5

2022-10-18

Symptoms: Dizziness and headaches continue. Went to a neurologist who said that the dizziness could be from covid booster. She will do further testing to rule out other things.

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	SARS-CoV-2 test	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Emergency care	·	·	✓
SD	Head titubation	·	·	✓
SD	Headache	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Pain in extremity	✓	✓	✓

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