Z3R-11068-37091

3 vaccinations 5 coded responses 22 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 100 / NY
Registered: 2021-01-22

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

2021-01-22
Registered in v-safe
2021-01-22
Dose 1 — Moderna
2021-01-22
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus headache — Feeling: Good · Headache, Fatigue or tiredness

Free text: I think its a sinus headache and probably not the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-19
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-28
Survey response — day 7, dose 2
MedDRA: Fatigue, Nausea, Pain, Pain in extremity, Pyrexia — Feeling: Good · Fatigue or tiredness

Free text: I had the shot a week ago fri. I had a sore arm body aches and a minor fever for 2 days. Then nothing for a day then 2 days of fatigue, nausea, body aches. Then some fatigue off and on. It lasted longer than I expected - for a week

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-01
Dose 3 — Moderna
2022-02-19
Survey response — 12 months, dose 2
MedDRA: Acupuncture, Fatigue, Laboratory test abnormal, Nasopharyngitis, Pain, Pyrexia, Respiratory tract congestion, Sinusitis — 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 · Telehealth, virtual health, or email health consultation

Free text: Symptoms: I tested positive with a home test. Dec 30. Had fever 101, aches, congestion for 3 or 4 days. Then as if recovering from a cold. Then sinusitis and fatigue. About 1 mo altogether. I tested negative with a home test after about 2 weeks. · Healthcare visit (other): Acupuncture towards the end

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Report sent to call center — 12 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-22
Call 1 — Left Voicemail
2022-05-04
Survey response — 6 months, dose 3
MedDRA: Fatigue, Office visit, Pain, Pyrexia, SARS-CoV-2 test positive, Sinusitis — 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

Free text: Symptoms: In Jan Intested positive for Covid with a rapid test. 4 days of 101 fever, aches and fatigue. A week or two later it went o my sinuses and I had fatigue and sinusitis for 2-3 weeks. · Healthcare visit (other): Saw my primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
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

1 call case(s)
2022-05-05
Call 1 — Left Voicemail
2022-05-09
Call 2 — Could Not Reach Participant
2022-11-01
Survey response — 12 months, dose 3
MedDRA: Adverse reaction, Impaired work ability, Medical counselling — 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

Free text: Symptoms: Very mild symptoms for maybe 4 days Unable to work etc primarily to not expose others · Healthcare visit (other): Phone with Dr.

MedDRA releases: 2024-11 · check-in free text available
2022-11-01
Report sent to call center — 12 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

1 call case(s)
2022-11-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	Moderna
3	2021-11-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-02-19	Successful 2022-11-02	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-04	Successful 2022-11-02	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

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-28

Systemic reaction (other): I think its a sinus headache and probably not the vaccine

Release 4 — day 7, dose 2

2021-02-28

Systemic reaction (other): I had the shot a week ago fri. I had a sore arm body aches and a minor fever for 2 days. Then nothing for a day then 2 days of fatigue, nausea, body aches. Then some fatigue off and on. It lasted longer than I expected - for a week

Release 11 — 12 months, dose 2

2022-02-19

Symptoms: I tested positive with a home test. Dec 30. Had fever 101, aches, congestion for 3 or 4 days. Then as if recovering from a cold. Then sinusitis and fatigue. About 1 mo altogether. I tested negative with a home test after about 2 weeks.

Healthcare visit (other): Acupuncture towards the end

Release 11 — 6 months, dose 3

2022-05-04

Symptoms: In Jan Intested positive for Covid with a rapid test. 4 days of 101 fever, aches and fatigue. A week or two later it went o my sinuses and I had fatigue and sinusitis for 2-3 weeks.

Healthcare visit (other): Saw my primary care physician

Release 12 — 12 months, dose 3

2022-11-01

Symptoms: Very mild symptoms for maybe 4 days Unable to work etc primarily to not expose others

Healthcare visit (other): Phone with Dr.

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	Acupuncture	·	·	✓
HCVO	Medical counselling	·	·	✓
HCVO	Office visit	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Fatigue	·	·	✓
SD	Impaired work ability	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Sinus headache	✓	✓	✓

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