YXM-21869-36438

4 vaccinations 10 coded responses 55 check-ins 9 free-text entries 5 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 525 / IA
Registered: 2021-03-09

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

Registered dependents

55Z-25295-03017 Child or adolescent in my care · Male · 2021-11-08

Timeline

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

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Moderna
2021-03-09
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: I have a fractured leg, crutches could be contributing to some of the muscle aches but not all.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Chills, Muscle or body aches, Nausea, Diarrhea

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Diarrhea

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: No symptoms not related to my broken leg

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-23
Survey response — day 14, dose 1
MedDRA: Headache, Herpes virus infection, Malaise, Oral pain, Pyrexia — Feeling: Fair

Free text: I believe the vaccine caused a herpes outbreak (I get them whenever my immune system is affected in any way) I have sores in my mouth, low fever (99.4 at the highest), a headache, and general malaise. I was not exposed to COVID that I know of.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-04-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-07
Survey response — 3 months, dose 2
MedDRA: Arthropod bite, Lyme disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I contracted Lyme disease from a tic bite.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-07
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-15
Dose 3 — Moderna
2021-11-15
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-17
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-18
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction, Pyrexia — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Free text: My fever has gone down some, to 101*F. I feel a little better today than yesterday, I'm on the mend.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site erythema, Medical counselling, Unevaluable event — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Nausea, Diarrhea · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): The redness around my injection site is quite large and is not shrinking. Public Health said I must monitor the size and I may need to see a doctor if it increases. It is currently larger than my hand, and I have drawn a pen line around it. · Healthcare visit (other): I called the Department of Public Health for advice

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Diarrhea

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-22
Health check-in — day 7, dose 3
Feeling: Good · Site: Itching · Diarrhea

Adult check-in
2021-11-23
Call successful
Does not wish to fill out VAERS report
2021-11-29
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-13
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-20
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-27
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-14
Survey response — 3 months, dose 3
MedDRA: Fatigue, Morning sickness, Nausea — Feeling: Fair

Free text: Nausea (morning sickness) and fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Survey response — 6 months, dose 3
MedDRA: Abortion spontaneous, Surgery, Uterine dilation and curettage — Feeling: Fair · 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: Symptoms: Miscarriage · Healthcare visit (other): Outpatient surgery-D&C

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-17
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-26
Dose 4 — Pfizer-BioNTech
2022-10-26
Health check-in — day 0, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2022-10-27
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease, Pregnancy, Subchorionic haematoma — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Oozing from my subchorionic hematoma (I'm pregnant and it had stopped bleeding, the oozing may or may not be related to the vaccine)

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2022-10-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Swelling, Itching · Headache

Adult check-in
2022-10-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-01
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fever · Chills, Headache · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2022-11-01
Report sent to call center — days 1–6 daily, dose 4
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-02
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-09
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-07
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-25
Survey response — 3 months, dose 4
MedDRA: Pregnancy — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-01-25
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-01-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-26
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna
3	2021-11-15	Moderna	No
4	2022-10-26	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-07	Successful 2021-07-13	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-19	Successful 2021-11-23	Does not wish to fill out VAERS report
2022-05-16	Successful 2022-05-17	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-01	Successful 2022-11-02	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-01-25	Successful 2023-01-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-10

Systemic reaction (other): I have a fractured leg, crutches could be contributing to some of the muscle aches but not all.

2021-03-14

Systemic reaction (other): No symptoms not related to my broken leg

Release 6 — day 14, dose 1

2021-03-23

Symptoms: I believe the vaccine caused a herpes outbreak (I get them whenever my immune system is affected in any way) I have sores in my mouth, low fever (99.4 at the highest), a headache, and general malaise. I was not exposed to COVID that I know of.

Release 9 — 3 months, dose 2

2021-07-07

Symptoms: I contracted Lyme disease from a tic bite.

Release 10 — days 1–6 daily, dose 3

2021-11-18

Systemic reaction (other): My fever has gone down some, to 101*F. I feel a little better today than yesterday, I'm on the mend.

2021-11-19

Systemic reaction (other): The redness around my injection site is quite large and is not shrinking. Public Health said I must monitor the size and I may need to see a doctor if it increases. It is currently larger than my hand, and I have drawn a pen line around it.

Healthcare visit (other): I called the Department of Public Health for advice

Release 11 — 3 months, dose 3

2022-02-14

Symptoms: Nausea (morning sickness) and fatigue

Release 11 — 6 months, dose 3

2022-05-16

Symptoms: Miscarriage

Healthcare visit (other): Outpatient surgery-D&C

Release 12 — days 1–6 daily, dose 4

2022-10-27

Systemic reaction (other): Oozing from my subchorionic hematoma (I'm pregnant and it had stopped bleeding, the oozing may or may not be related to the vaccine)

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	Surgery	·	·	✓
HCVO	Unevaluable event	·	·	✓
HCVO	Uterine dilation and curettage	·	·	✓
SD	Abortion spontaneous	·	·	✓
SD	Arthropod bite	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Herpes virus infection	✓	✓	✓
SD	Lyme disease	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Morning sickness	·	·	✓
SD	Nausea	·	·	✓
SD	Oral pain	✓	✓	✓
SD	Pregnancy	·	·	✓
SD	Pyrexia	✓	✓	✓
SRO	Adverse reaction	·	·	✓
SRO	Injection site erythema	·	·	✓
SRO	Medical counselling	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pregnancy	·	·	✓
SRO	Pyrexia	·	·	✓
SRO	Subchorionic haematoma	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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