Z4R-69286-54480

4 vaccinations 16 coded responses 55 check-ins 16 free-text entries 3 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 222 / VA
Registered: 2021-03-12

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

2021-03-12
Registered in v-safe
2021-03-12
Dose 1 — Moderna
2021-03-12
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Fatigue — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Felt a little faint right when I woke up but laid down and felt better. Have not extended myself physically today as I did yesterday either and have felt less fatigued overal.

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 · Site: Pain · None

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Injection site pain — Feeling: Good · Site: Pain

Free text: Tired but not so much to call it fatigue. Much less pain in injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Pain in injection site is only noticeable when touched. No other issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-11
Dose 2 — Moderna
2021-04-11
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-12
Survey response — days 1–6 daily, dose 2
MedDRA: Tenderness — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Tenderness to touch - all over body. I think perhaps similar to body aches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-15
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Severe dizziness upon waking this morning that lasted for 4 hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-18
Survey response — day 7, dose 2
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: Not sure if fatigue from seasonal allergies or vaccine. But it is mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-11
Survey response — 3 months, dose 2
MedDRA: Conjunctivitis — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Pink eye/ conjunctivitis

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

1 call case(s)
2021-07-16
Call 1 — Left Voicemail
2021-11-19
Dose 3 — Pfizer-BioNTech
2021-11-19
Survey response — day 0, dose 3
MedDRA: Dysgeusia, Office visit, SARS-CoV-2 test negative — Feeling: Good

Free text: Metallic taste in mouth but have repeatedly tested negative for COVID since taste began. Working with dentist & doctor to diagnose.

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-03
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 21, dose 3
MedDRA: Gastrointestinal disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Ongoing issues with digestion that started long before booster shot but have worsened some recently.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-13
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-17
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-24
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-19
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-28
Dose 4 — Pfizer-BioNTech
2022-04-28
Survey response — day 0, dose 4
MedDRA: Pre-existing disease — Feeling: Good · Site: Pain

Free text: Seasonal allergies

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-30
Survey response — days 1–6 daily, dose 4
MedDRA: Axillary pain, Tenderness — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Armpit under arm where vaccine administered was very sore/tender. Maybe lymph nodes?

MedDRA releases: 2024-11 · check-in free text available
2022-05-01
Survey response — days 1–6 daily, dose 4
MedDRA: Axillary pain — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Mild soreness in armpit under arm where injection administered

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Survey response — days 1–6 daily, dose 4
MedDRA: Axillary pain — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Still a little sore under left armpit

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Survey response — days 1–6 daily, dose 4
MedDRA: Tenderness — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Underarm area under left arm still a little tender

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — days 1–6 daily, dose 4
MedDRA: Tenderness — Feeling: Good · Site: Pain · Headache

Free text: Slight tenderness under left armpit

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-12
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-19
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-26
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-09
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-28
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-27
Survey response — 6 months, dose 4
MedDRA: COVID-19 — 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 · Telehealth, virtual health, or email health consultation

Free text: Covid 19 infection

MedDRA releases: 2024-11 · check-in free text available
2022-10-27
Report sent to call center — 6 months, dose 4
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)
2022-10-28
Call 1 — Could Not Reach Participant
2022-11-02
Call 2 — Left Voicemail
2023-04-28
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-04-11	Moderna
3	2021-11-19	Pfizer-BioNTech	No
4	2022-04-28	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-11	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-10	Successful 2021-12-13	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-27	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-14

Systemic reaction (other): Felt a little faint right when I woke up but laid down and felt better. Have not extended myself physically today as I did yesterday either and have felt less fatigued overal.

2021-03-16

Systemic reaction (other): Tired but not so much to call it fatigue. Much less pain in injection site

2021-03-17

Systemic reaction (other): Pain in injection site is only noticeable when touched. No other issues

Release 7 — days 1–6 daily, dose 2

2021-04-12

Systemic reaction (other): Tenderness to touch - all over body. I think perhaps similar to body aches.

2021-04-15

Systemic reaction (other): Severe dizziness upon waking this morning that lasted for 4 hours

Release 7 — day 7, dose 2

2021-04-18

Systemic reaction (other): Not sure if fatigue from seasonal allergies or vaccine. But it is mild

Release 9 — 3 months, dose 2

2021-07-11

Symptoms: Pink eye/ conjunctivitis

Release 10 — day 0, dose 3

2021-11-19

Systemic reaction (other): Metallic taste in mouth but have repeatedly tested negative for COVID since taste began. Working with dentist & doctor to diagnose.

Release 10 — day 21, dose 3

2021-12-10

Symptoms: Ongoing issues with digestion that started long before booster shot but have worsened some recently.

Release 11 — day 0, dose 4

2022-04-28

Systemic reaction (other): Seasonal allergies

Release 11 — days 1–6 daily, dose 4

2022-04-30

Systemic reaction (other): Armpit under arm where vaccine administered was very sore/tender. Maybe lymph nodes?

2022-05-01

Systemic reaction (other): Mild soreness in armpit under arm where injection administered

2022-05-02

Systemic reaction (other): Still a little sore under left armpit

2022-05-03

Systemic reaction (other): Underarm area under left arm still a little tender

2022-05-04

Systemic reaction (other): Slight tenderness under left armpit

Release 12 — 6 months, dose 4

2022-10-27

Symptoms: Covid 19 infection

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
SD	Conjunctivitis	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysgeusia	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Office visit	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	SARS-CoV-2 test negative	·	·	✓
SRO	Tenderness	✓	✓	✓

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