YY5-55135-88297

3 vaccinations 17 coded responses 43 check-ins 16 free-text entries 7 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 018 / MA
Registered: 2021-08-16

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

WAF-34004-46229 Child or adolescent in my care · Female · 2021-10-24

24E-18691-23051 Child or adolescent in my care · Female · 2021-10-24

Timeline

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

2021-08-16
Registered in v-safe
2021-08-16
Dose 1 — Moderna
2021-08-16
Survey response — day 0, dose 1
MedDRA: Office visit, Throat irritation — Feeling: Fair · Site: Pain, Itching · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Itchy throat · Healthcare visit (other): Just to monitor the itchiness on my throat they end up having me take Claritin

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — day 0, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-17
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Swelling

Free text: Dizziness

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-18
Survey response — days 1–6 daily, dose 1
MedDRA: Anxiety, Dizziness, Hot flush, Hyperhidrosis — Feeling: Poor · Site: Pain, Swelling · Headache, Nausea · Be unable to do your normal daily activities

Free text: Anxiety, hot flashes and sweats, dizziness

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction, Dehydration, Pregnancy, Uterine contractions during pregnancy — Feeling: Fair · Site: Pain · Abdominal pain · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Dehydration , braxon Hicks ( Im 25 wks pregnant ) was delevoping contractions every 3-5 mins · Healthcare visit (other): They where monitoring the baby but they mentioned it was the covid 19 moderna side effect .. no preterm labor

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-19
Call 2 — Could Not Reach Participant
2021-08-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-08-20
Call 2 — Could Not Reach Participant
2021-08-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activities

Adult check-in
2021-08-22
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair

Free text: Dizziness

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-08-23
Callback requested for
08:00AM ET
2021-08-24
Call 3 — Could Not Reach Participant
2021-08-24
Callback requested for
08:00AM ET
2021-08-30
Survey response — day 14, dose 1
MedDRA: Chest pain — Feeling: Good

Free text: Chest pain

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-09-13
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-09-20
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-09-27
Health check-in — day 42, dose 1
Feeling: Good

Adult check-in
2021-10-18
Dose 2 — Moderna
2021-10-18
Survey response — day 0, dose 2
MedDRA: Dry throat — Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Free text: Dry throat

MedDRA releases: 2024-11 · check-in free text available
2021-10-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-10-20
Survey response — days 1–6 daily, dose 2
MedDRA: Vertigo — Feeling: Good · Site: Pain, Swelling · Headache

Free text: Vertigo

MedDRA releases: 2024-11 · check-in free text available
2021-10-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-10-22
Survey response — days 1–6 daily, dose 2
MedDRA: Emergency care, Pregnancy — Feeling: Fair · Site: Pain · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Contractions · Healthcare visit (other): Labor and delivery

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-10-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-10-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-25
Survey response — day 7, dose 2
MedDRA: Vertigo — Feeling: Good

Free text: Vertigo

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Call 2 — Could Not Reach Participant
2021-10-28
Call 3 — Could Not Reach Participant
2021-11-01
Survey response — day 14, dose 2
MedDRA: Headache, Injection site pain, Vertigo — Feeling: Good · Be unable to do your normal daily activities

Free text: Pain in the injection site , headaches, virtigo

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-11-17
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-11-23
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-12-01
Survey response — day 42, dose 2
MedDRA: Hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Highblood pressure · Healthcare visit (other): High blood pressure

MedDRA releases: 2024-11 · check-in free text available
2021-12-01
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-12-02
Call 2 — Could Not Reach Participant
2021-12-07
Call 3 — Could Not Reach Participant
2022-01-17
Survey response — 3 months, dose 2
MedDRA: Hypertension, Ophthalmic migraine, Pre-eclampsia, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Highblood pressure · Healthcare visit (other): Developed post preeclampsia and chronic high blood pressure , ocular migraines

MedDRA releases: 2024-11 · check-in free text available
2022-01-17
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-01-18
Call 1 — Could Not Reach Participant
2022-04-20
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-06-23
Dose 3 — Moderna
2022-06-23
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2022-06-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-06-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Nausea

Adult check-in
2022-06-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-06-27
Survey response — days 1–6 daily, dose 3
MedDRA: Back pain, Chest pain, Pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Lower back pain on my left side and radiates towards front · Healthcare visit (other): Lower left back pain and front level of pain 8

MedDRA releases: 2024-11 · check-in free text available
2022-06-27
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-06-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache

Adult check-in
2022-06-28
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-28
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-06-30
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-07-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-07-14
Survey response — day 21, dose 3
MedDRA: Migraine with aura — Feeling: Fair

Free text: Migraine aura

MedDRA releases: 2024-11 · check-in free text available
2022-07-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-07-31
Survey response — day 35, dose 3
MedDRA: Hypertension, Migraine with aura — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Worse migraines aura and high blood pressure

MedDRA releases: 2024-11 · check-in free text available
2022-07-31
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 2 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-09-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-12-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-06-23
Survey response — 12 months, dose 3
MedDRA: COVID-19, Delivery, Hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-16	Moderna	No
2	2021-10-18	Moderna	No
3	2022-06-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-16	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-19	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-22	Successful 2022-06-28	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-01	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-01-17	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-27	Successful 2022-06-28	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-31	Unsuccessful

Free text

Release 9 — day 0, dose 1

2021-08-16

Systemic reaction (other): Itchy throat

Healthcare visit (other): Just to monitor the itchiness on my throat they end up having me take Claritin

Release 9 — days 1–6 daily, dose 1

2021-08-17

Systemic reaction (other): Dizziness

2021-08-18

Systemic reaction (other): Anxiety, hot flashes and sweats, dizziness

2021-08-19

Systemic reaction (other): Dehydration , braxon Hicks ( Im 25 wks pregnant ) was delevoping contractions every 3-5 mins

Healthcare visit (other): They where monitoring the baby but they mentioned it was the covid 19 moderna side effect .. no preterm labor

2021-08-22

Systemic reaction (other): Dizziness

Release 9 — day 14, dose 1

2021-08-30

Symptoms: Chest pain

Release 10 — day 0, dose 2

2021-10-18

Systemic reaction (other): Dry throat

Release 10 — days 1–6 daily, dose 2

2021-10-20

Systemic reaction (other): Vertigo

2021-10-22

Systemic reaction (other): Contractions

Healthcare visit (other): Labor and delivery

Release 10 — day 7, dose 2

2021-10-25

Systemic reaction (other): Vertigo

Release 10 — day 14, dose 2

2021-11-01

Symptoms: Pain in the injection site , headaches, virtigo

Release 10 — day 42, dose 2

2021-12-01

Symptoms: Highblood pressure

Healthcare visit (other): High blood pressure

Release 10 — 3 months, dose 2

2022-01-17

Symptoms: Highblood pressure

Healthcare visit (other): Developed post preeclampsia and chronic high blood pressure , ocular migraines

Release 12 — days 1–6 daily, dose 3

2022-06-27

Systemic reaction (other): Lower back pain on my left side and radiates towards front

Healthcare visit (other): Lower left back pain and front level of pain 8

Release 12 — day 21, dose 3

2022-07-14

Symptoms: Migraine aura

Release 12 — day 35, dose 3

2022-07-31

Symptoms: Worse migraines aura and high blood pressure

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	Adverse reaction	✓	·	✓
HCVO	Back pain	·	·	✓
HCVO	Chest pain	·	·	✓
HCVO	COVID-19	·	·	✓
HCVO	Delivery	·	·	✓
HCVO	Emergency care	·	·	✓
HCVO	Foetal monitoring	○	·	○
HCVO	Hypertension	·	·	✓
HCVO	Immunisation reaction	○	·	○
HCVO	Office visit	✓	·	✓
HCVO	Ophthalmic migraine	·	·	✓
HCVO	Pre-eclampsia	·	·	✓
HCVO	Pre-existing disease	·	·	✓
HCVO	Pregnancy	✓	·	✓
HCVO	Throat irritation	✓	·	✓
SD	Chest pain	✓	·	✓
SD	Headache	·	·	✓
SD	Hypertension	·	·	✓
SD	Injection site pain	·	·	✓
SD	Migraine with aura	·	·	✓
SD	Vertigo	·	·	✓
SRO	Anxiety	✓	·	✓
SRO	Back pain	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Dehydration	✓	·	✓
SRO	Dizziness	✓	·	✓
SRO	Dry throat	·	·	✓
SRO	Hot flush	✓	·	✓
SRO	Hyperhidrosis	✓	·	✓
SRO	Pain	·	·	✓
SRO	Pregnancy	○	·	✓
SRO	Throat irritation	✓	·	✓
SRO	Uterine contractions during pregnancy	✓	·	✓
SRO	Vertigo	·	·	✓

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