22M-10550-59293

3 vaccinations 7 coded responses 40 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 490 / MI
Registered: 2021-01-14

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Survey response — day 35, dose 2
MedDRA: Diarrhoea, Nausea — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Nausea and diarrhea. Dont think it had anything to do with vaccine because other family members had similar issues.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 42, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-03
Dose 3 — Moderna
2021-12-03
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-12-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-09
Survey response — days 1–6 daily, dose 3
MedDRA: Diarrhoea, Vomiting — Feeling: Good · Vomiting, Diarrhea

Free text: Vomiting and diarrhea was last night. I believe was related to a food issue but can't figure out what exactly.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-17
Survey response — day 14, dose 3
MedDRA: Mastitis, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Infection in breast. Believe it is in a duct. Had same issue several months back.

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-24
Survey response — day 21, dose 3
MedDRA: Breast inflammation, Mastitis, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Continued inflammation/infection in left breast · Healthcare visit (other): Doctor's visit in person

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-27
Call successful
Participant prefers to complete VAERS report online
2021-12-31
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-04
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-03
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-05
Survey response — 12 months, dose 3
MedDRA: Diverticulitis, Herpes zoster, Hypersensitivity — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Shingles, diverticulitis, random unknown allergy

MedDRA releases: 2024-11 · check-in free text available
2022-12-05
Report sent to call center — 12 months, dose 3
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 · Emergency room or emergency department visit · 1 call case(s)
2022-12-06
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-12-03	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Sore throat

Release 5 — day 35, dose 2

2021-03-18

Symptoms: Nausea and diarrhea. Dont think it had anything to do with vaccine because other family members had similar issues.

Release 6 — day 42, dose 2

2021-03-25

Symptoms: Headache

Release 10 — days 1–6 daily, dose 3

2021-12-09

Systemic reaction (other): Vomiting and diarrhea was last night. I believe was related to a food issue but can't figure out what exactly.

Release 10 — day 14, dose 3

2021-12-17

Symptoms: Infection in breast. Believe it is in a duct. Had same issue several months back.

Release 10 — day 21, dose 3

2021-12-24

Symptoms: Continued inflammation/infection in left breast

Healthcare visit (other): Doctor's visit in person

Release 12 — 12 months, dose 3

2022-12-05

Symptoms: Shingles, diverticulitis, random unknown allergy

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	Breast inflammation	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Diverticulitis	·	·	✓
SD	Headache	✓	✓	✓
SD	Herpes zoster	·	·	✓
SD	Hypersensitivity	·	·	✓
SD	Mastitis	·	·	✓
SD	Nausea	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SRO	Diarrhoea	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Vomiting	·	·	✓

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