ZA4-11871-49157

5 vaccinations 7 coded responses 23 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 958 / CA
Registered: 2021-03-17

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

2021-03-17
Registered in v-safe
2021-03-17
Dose 1 — Moderna
2021-03-17
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Injection site pain, Pain, Pain in extremity — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Injection pain site is minimal, but pain radiates down to my hand, this is worse; moderate. Also I had a headache yesterday after I had finished reporting symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Hand on shot arm still aches, not as bad as yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Nausea

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Survey response — day 7, dose 1
MedDRA: Abdominal pain, Pre-existing disease — Feeling: Good

Free text: Chronic abdominal pain long term.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-05-14
Dose 2 — Moderna
2021-09-15
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in
2021-11-11
Dose 3 — Moderna
2022-03-17
Survey response — 12 months, dose 1
MedDRA: Dyspnoea — 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, Outpatient clinic or urgent care clinic visit

Free text: Severe shortness of breath at rest; started Tespire. Sx have improved significantly past 2 weeks

MedDRA releases: 2024-11 · check-in free text available
2022-03-17
Report sent to call center — 12 months, dose 1
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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-22
Call 1 — Left Voicemail
2022-05-10
Dose 4 — Pfizer-BioNTech
2022-06-01
Survey response — day 21, dose 4
MedDRA: Asthma, General physical health deterioration, Pre-existing disease — 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, Outpatient clinic or urgent care clinic visit

Free text: Further deterioration due to COPD, asthma also increased sx this winter 2021/22. Started Tezpire 3/2022

MedDRA releases: 2024-11 · check-in free text available
2022-06-01
Report sent to call center — day 21, 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-02
Call 2 — Left Voicemail
2022-06-02
Call 1 — Left Voicemail
2022-06-07
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-15
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-22
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-08-09
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-07
Dose 5 — Pfizer-BioNTech
2022-10-14
Health check-in — day 7, dose 5
Feeling: Fair · Fatigue or tiredness, Abdominal pain

Adult check-in
2022-10-28
Survey response — day 21, dose 5
MedDRA: Oropharyngeal pain — Feeling: Fair

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Survey response — day 28, dose 5
MedDRA: Nasopharyngitis, SARS-CoV-2 test negative, Sinusitis — Feeling: Good

Free text: Got a cold, now have a sinus infection. Covid test neg x 3.

MedDRA releases: 2024-11 · check-in free text available
2022-11-11
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-18
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-06
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-07
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-05-14	Moderna	No
3	2021-11-11	Moderna	No
4	2022-05-10	Pfizer-BioNTech	No
5	2022-10-07	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-17	Unsuccessful
2022-06-01	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): Injection pain site is minimal, but pain radiates down to my hand, this is worse; moderate. Also I had a headache yesterday after I had finished reporting symptoms.

2021-03-19

Systemic reaction (other): Hand on shot arm still aches, not as bad as yesterday.

Release 6 — day 7, dose 1

2021-03-24

Systemic reaction (other): Chronic abdominal pain long term.

Release 11 — 12 months, dose 1

2022-03-17

Symptoms: Severe shortness of breath at rest; started Tespire. Sx have improved significantly past 2 weeks

Release 11 — day 21, dose 4

2022-06-01

Symptoms: Further deterioration due to COPD, asthma also increased sx this winter 2021/22. Started Tezpire 3/2022

Release 12 — day 21, dose 5

2022-10-28

Symptoms: Sore throat

Release 12 — day 28, dose 5

2022-11-06

Symptoms: Got a cold, now have a sinus infection. Covid test neg x 3.

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	Asthma	·	·	✓
SD	Dyspnoea	·	·	✓
SD	General physical health deterioration	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Abdominal pain	○	✓	○
SRO	Headache	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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