Z3U-33479-62951

4 vaccinations 10 coded responses 50 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 983 / WA
Registered: 2021-01-28

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

2021-01-28
Registered in v-safe
2021-01-28
Dose 1 — Moderna
2021-01-28
Survey response — day 0, dose 1
MedDRA: Hypoaesthesia oral, Immediate post-injection reaction, Paraesthesia oral, Self-medication — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Within 30 minutes some slight tingling and numbness of lips and tongue. Pharmacist gave me benadryl and water.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Chills, Headache

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · Chills, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

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

Adult check-in
2021-03-04
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-26
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2021-10-25
Survey response — day 0, dose 3
MedDRA: Immediate post-injection reaction, Paraesthesia oral, Self-medication, Tongue dry — Feeling: Good · Site: Pain · Chills, Headache, Nausea

Free text: Tongue felt slighty drya and tingly so I took Benadryl as directed. Within first half hour after shot.

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-01
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-01
Dose 4 — Moderna
2022-04-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-04-04
Survey response — days 1–6 daily, dose 4
MedDRA: Ear discomfort, Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Some fullness in ears. Lymph nodes enlarged.

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
Survey response — days 1–6 daily, dose 4
MedDRA: Medical counselling — Feeling: Fair · Headache · Get care from a doctor or other healthcare professional

Free text: Office call

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
Report sent to call center — days 1–6 daily, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-08
Survey response — day 7, dose 4
MedDRA: Insomnia — Feeling: Fair · Headache

Free text: Not sleeping

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Call 1 — Left Voicemail
2022-04-15
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-22
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-29
Survey response — day 28, dose 4
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat,Congestion

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-02
Call 1 — Left Voicemail
2022-05-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-14
Survey response — day 42, dose 4
MedDRA: Cough, Nasopharyngitis, Office visit, Respiratory tract congestion, Self-medication, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Common cold with cough and congestion turned into sinus infection. Taking antibiotics and cough medication and prebiotic. Improving. · Healthcare visit (other): Primary Care/Nurse Practitioner

MedDRA releases: 2024-11 · check-in free text available
2022-05-14
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-17
Call 2 — Left Voicemail
2022-05-17
Call 2 — Left Voicemail
2022-05-17
Call 2 — Left Voicemail
2022-07-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-01
Survey response — 6 months, dose 4
MedDRA: Fatigue, Headache, Hypersensitivity, Insomnia, Pain, Self-medication — Feeling: Good · Be unable to do your normal daily activities

Free text: Insomnia after 5th shot. Moderna Bivalent Vaccination. Allergic reaction treated with Benedryl. Aches and pains and headache.fatigue.

MedDRA releases: 2024-11 · check-in free text available
2023-04-01
Survey response — 12 months, dose 4
MedDRA: COVID-19 — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-01
Report sent to call center — 12 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-04-04
Call 1 — Left Voicemail
2023-04-04
Call 1 — Left Voicemail
2023-04-11
Call successful
Participant prefers to complete VAERS report online
2023-04-11
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-02-25	Moderna
3	2021-10-25	Moderna	No
4	2022-04-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-07	Successful 2022-05-12	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-29	Successful 2022-05-12	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-14	Successful 2023-04-11	Participant prefers to complete VAERS report online
2023-04-01	Successful 2023-04-11	Participant prefers to complete VAERS report online

Free text

Release 3 — day 0, dose 1

2021-01-28

Systemic reaction (other): Within 30 minutes some slight tingling and numbness of lips and tongue. Pharmacist gave me benadryl and water.

Release 3 — days 1–6 daily, dose 1

2021-01-30

Systemic reaction (other): Lightheaded

Release 10 — day 0, dose 3

2021-10-25

Systemic reaction (other): Tongue felt slighty drya and tingly so I took Benadryl as directed. Within first half hour after shot.

Release 11 — days 1–6 daily, dose 4

2022-04-04

Systemic reaction (other): Some fullness in ears. Lymph nodes enlarged.

2022-04-07

Healthcare visit (other): Office call

Release 11 — day 7, dose 4

2022-04-08

Systemic reaction (other): Not sleeping

Release 11 — day 28, dose 4

2022-04-29

Symptoms: Sore throat,Congestion

Release 11 — day 42, dose 4

2022-05-14

Symptoms: Common cold with cough and congestion turned into sinus infection. Taking antibiotics and cough medication and prebiotic. Improving.

Healthcare visit (other): Primary Care/Nurse Practitioner

Release 12 — 6 months, dose 4

2022-10-01

Symptoms: Insomnia after 5th shot. Moderna Bivalent Vaccination. Allergic reaction treated with Benedryl. Aches and pains and headache.fatigue.

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	Medical counselling	·	·	✓
HCVO	Office visit	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hypersensitivity	·	·	✓
SD	Insomnia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Self-medication	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear discomfort	·	·	✓
SRO	Hypoaesthesia oral	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Insomnia	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Tongue dry	·	·	✓

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