YX6-15351-13313

4 vaccinations 9 coded responses 50 check-ins 9 free-text entries 5 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 322 / FL
Registered: 2021-04-16

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

Registered dependents

952-20616-67406 Child or adolescent in my care · Male · 2021-11-09

JWA-31090-11412 Child or adolescent in my care · Male · 2021-11-09

Timeline

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

2021-04-16
Registered in v-safe
2021-04-16
Dose 1 — Moderna
2021-04-16
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-23
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-14
Dose 2 — Moderna
2021-05-14
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-05-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches

Adult check-in
2021-05-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-05-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-05-21
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-05-28
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-18
Survey response — day 35, dose 2
MedDRA: Headache, Myalgia, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Lots of headache, muscle pain · Healthcare visit (other): Chiropractor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-25
Survey response — day 42, dose 2
MedDRA: Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cold (sore throat, runny nose, congestion). Got it from my kids who tested negative for covid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Call 1 — Could Not Reach Participant
2021-06-30
Call 2 — Could Not Reach Participant
2021-08-13
Survey response — 3 months, dose 2
MedDRA: Hordeolum — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Stye on right eye

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Call 1 — Could Not Reach Participant
2021-08-23
Call 2 — Could Not Reach Participant
2021-11-12
Survey response — 6 months, dose 2
MedDRA: Back pain, Neck pain — 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 · Outpatient clinic or urgent care clinic visit

Free text: Severe neck and back pain. I don't think it's related to the vaccine, but I'm reporting all symptoms!

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-15
Call 1 — Could Not Reach Participant
2021-11-18
Call 2 — Could Not Reach Participant
2021-11-30
Dose 3 — Pfizer-BioNTech
2021-12-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-12-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-04
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness, Vertigo — Feeling: Good · Fatigue or tiredness

Free text: Vertigo/dizziness (since shot, very mild)

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-09
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-12-15
Health check-in — day 14, dose 3
Feeling: Good

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

Adult check-in
2022-01-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-11
Survey response — day 42, dose 3
MedDRA: Anaemia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diagnosed anemic, probably not related to vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-12
Call 1 — Left Voicemail
2022-03-01
Survey response — 3 months, dose 3
MedDRA: Anaemia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Anemia

MedDRA releases: 2024-11 · check-in free text available
2022-03-01
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-31
Survey response — 6 months, dose 3
MedDRA: Anaemia, COVID-19 — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Anemia, covid

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Dose 4 — Moderna
Co-administered: Flu
2022-10-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-10
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache

Adult check-in
2022-10-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-12
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache

Adult check-in
2022-10-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-14
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache

Adult check-in
2022-10-15
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-22
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-29
Survey response — day 21, dose 4
MedDRA: Unevaluable event — Feeling: Good

Free text: Headaches, but most likely caused by starting Wellbutrin

MedDRA releases: 2024-11 · check-in free text available
2022-11-07
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-11-12
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-07
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-08
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-16	Moderna
2	2021-05-14	Moderna
3	2021-11-30	Pfizer-BioNTech	No
4	2022-10-08	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-06-18	Unsuccessful
2021-08-13	Unsuccessful
2021-11-12	Unsuccessful
2022-01-11	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-01	Successful 2022-03-03	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 9 — day 35, dose 2

2021-06-18

Symptoms: Lots of headache, muscle pain

Healthcare visit (other): Chiropractor

Release 9 — day 42, dose 2

2021-06-25

Symptoms: Cold (sore throat, runny nose, congestion). Got it from my kids who tested negative for covid

Release 9 — 3 months, dose 2

2021-08-13

Symptoms: Stye on right eye

Release 10 — 6 months, dose 2

2021-11-12

Symptoms: Severe neck and back pain. I don't think it's related to the vaccine, but I'm reporting all symptoms!

Release 10 — days 1–6 daily, dose 3

2021-12-04

Systemic reaction (other): Vertigo/dizziness (since shot, very mild)

Release 10 — day 42, dose 3

2022-01-11

Symptoms: Diagnosed anemic, probably not related to vaccine

Release 11 — 3 months, dose 3

2022-03-01

Symptoms: Anemia

Release 11 — 6 months, dose 3

2022-05-31

Symptoms: Anemia, covid

Release 12 — day 21, dose 4

2022-10-29

Symptoms: Headaches, but most likely caused by starting Wellbutrin

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	✓	✓	✓
SD	Anaemia	·	·	✓
SD	Back pain	·	·	✓
SD	COVID-19	·	·	✓
SD	Headache	✓	✓	✓
SD	Hordeolum	✓	·	✓
SD	Myalgia	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Unevaluable event	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Vertigo	·	·	✓

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