ZQ9-31553-56182

3 vaccinations 8 coded responses 38 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 989 / WA
Registered: 2021-04-01

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

2021-04-01
Registered in v-safe
2021-04-01
Dose 1 — Moderna
2021-04-01
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

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

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Vertigo — Feeling: Fair · Fatigue or tiredness

Free text: Dizziness, vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: Woozy, dizzy - better than yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-22
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-29
Dose 2 — Moderna
2021-04-29
Survey response — day 0, dose 2
MedDRA: Rash, Self-medication — Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: I think I got this rash from the 1st shot, just didn't realize where it came from, thot it was just an allergy thing,but it's not gone away & antihistamines don't help

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-06
Health check-in — day 7, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-13
Survey response — day 14, dose 2
MedDRA: Dizziness — Feeling: Fair

Free text: Wooziness is back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-27
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-29
Survey response — 3 months, dose 2
MedDRA: Rash — Feeling: Fair

Free text: After my 2nd shot I developed an extreme rash. I think this vaccine accelerated/exacerbated my skin condition and it won't calm down now. But it could be weirdly coincidental.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-29
Survey response — 6 months, dose 2
MedDRA: Rheumatoid arthritis — 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 · Outpatient clinic or urgent care clinic visit

Free text: Onset of Rheumatoid arthritis, on Methotrexate now

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Report sent to call center — 6 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-30
Dose 3 — Moderna
Co-administered: Flu
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · None

Adult check-in
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Call 1 — Could Not Reach Participant
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Call successful
Participant prefers to complete VAERS report online
2021-11-06
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-13
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-20
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-11
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-29
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-30
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-10-30
Survey response — 12 months, dose 3
MedDRA: COVID-19 pneumonia — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Covid Pneumonia

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-01	Moderna
2	2021-04-29	Moderna
3	2021-10-30	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-10-29	Successful 2021-11-05	Participant prefers to complete VAERS report online
2022-10-30	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-07

Systemic reaction (other): Dizziness, vertigo

Release 7 — day 7, dose 1

2021-04-08

Systemic reaction (other): Woozy, dizzy - better than yesterday

Release 8 — day 0, dose 2

2021-04-29

Systemic reaction (other): I think I got this rash from the 1st shot, just didn't realize where it came from, thot it was just an allergy thing,but it's not gone away & antihistamines don't help

Release 8 — day 14, dose 2

2021-05-13

Symptoms: Wooziness is back

Release 9 — 3 months, dose 2

2021-07-29

Symptoms: After my 2nd shot I developed an extreme rash. I think this vaccine accelerated/exacerbated my skin condition and it won't calm down now. But it could be weirdly coincidental.

Release 10 — 6 months, dose 2

2021-10-29

Symptoms: Onset of Rheumatoid arthritis, on Methotrexate now

Release 10 — days 1–6 daily, dose 3

2021-11-02

Systemic reaction (other): Dizziness

Release 12 — 12 months, dose 3

2022-10-30

Symptoms: Covid Pneumonia

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	COVID-19 pneumonia	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Rash	✓	·	✓
SD	Rheumatoid arthritis	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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