Z9X-17478-79696

4 vaccinations 13 coded responses 50 check-ins 13 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 493 / MI
Registered: 2021-03-06

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

2021-03-06
Registered in v-safe
2021-03-06
Dose 1 — Moderna
2021-03-06
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: Na

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — day 7, dose 1
MedDRA: No adverse event — Feeling: Good

Free text:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-03
Dose 2 — Moderna
2021-04-03
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: Its only been an hour - no symptoms yet.

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

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Urinary tract infection — Feeling: Poor · Site: Itching · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Think I might have a UTI causing symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · 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 · Fatigue or tiredness

Adult check-in
2021-04-10
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-02
Survey response — 6 months, dose 2
MedDRA: Cough, Malaise, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school

Free text: And I was quite sick in early August with upper respiratory and convulsive coughing. Took more than a month to recover fully. Had a Covid test in the first week result was negative.

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Dose 3 — Pfizer-BioNTech
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Chills, Injection site pain, Pain — Feeling: Good

Free text: I had mild chills and body aches 14 hours after my shot. Lasted a couple of days. Pain at injection site about 24 to 48 hrs.

MedDRA releases: 2024-11 · check-in free text available
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
2021-11-09
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
2021-11-22
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
2022-04-25
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-27
Dose 4 — Moderna
2022-04-28
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-04-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-04-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-04
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-11
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-18
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-25
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-01
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-08
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-27
Survey response — 3 months, dose 4
MedDRA: COVID-19, Malaise, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had Covid again June 28th. Quite sick for 3 -5 days · Healthcare visit (other): Saw my GP DR

MedDRA releases: 2024-11 · check-in free text available
2022-07-27
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-29
Call 1 — Requested Callback
2022-07-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-28
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-27
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Moderna
2	2021-04-03	Moderna
3	2021-10-25	Pfizer-BioNTech	No
4	2022-04-27	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-07-27	Successful 2022-07-29	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — day 0, dose 1

2021-03-06

Release 5 — days 1–6 daily, dose 1

2021-03-07

2021-03-08

Systemic reaction (other): Na

Release 5 — day 7, dose 1

2021-03-13

Release 6 — day 0, dose 2

2021-04-03

Systemic reaction (other): Its only been an hour - no symptoms yet.

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Think I might have a UTI causing symptoms.

Release 9 — 6 months, dose 2

2021-10-02

Symptoms: And I was quite sick in early August with upper respiratory and convulsive coughing. Took more than a month to recover fully. Had a Covid test in the first week result was negative.

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): I had mild chills and body aches 14 hours after my shot. Lasted a couple of days. Pain at injection site about 24 to 48 hrs.

Release 12 — 3 months, dose 4

2022-07-27

Symptoms: Had Covid again June 28th. Quite sick for 3 -5 days

Healthcare visit (other): Saw my GP 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	Office visit	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Malaise	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Chills	·	·	✓
SRO	Injection site pain	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain	·	·	✓
SRO	Unevaluable event	✓	✓	✓
SRO	Urinary tract infection	✓	✓	✓

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