28E-21431-31536

5 vaccinations 25 coded responses 56 check-ins 19 free-text entries 11 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 303 / GA
Registered: 2021-01-23

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Moderna
2021-01-23
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Survey response — day 14, dose 1
MedDRA: Gingival swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: Swollen gums on upper left side of teeth not related to vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-20
Dose 2 — Moderna
2021-02-20
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain upper, Back pain — Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Free text: Stomach cramps with low back pain on and off since I got the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Survey response — day 14, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Chronic bowel evacuation issue has gotten worse. Not sure if there is a relationship between the vaccine and this condition.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — day 21, dose 2
MedDRA: Abdominal pain upper, Gastritis, Nausea, Office visit, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Nausea and stomach cramps, prolly tied to my gastritis · Healthcare visit (other): Personal visit with my doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-20
Survey response — day 28, dose 2
MedDRA: Nausea, Oesophagitis — Feeling: Good · 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: Esophagus inflamation and nausea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-03
Survey response — day 42, dose 2
MedDRA: Back pain, Fatigue, Piriformis syndrome, Reaction to previous exposure to any vaccine — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue, pain in lower back similar to pain experienced after my shots, pain in left piraformis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Survey response — 3 months, dose 2
MedDRA: Back pain, Bowel movement irregularity, Telemedicine — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Lower back pain that impacts my ability to move my bowels. Similar pain that I got after my vaccine. · Healthcare visit (other): Metabolic testing, physical therapy, virtual consultation with Dr.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-21
Survey response — 6 months, dose 2
MedDRA: Anxiety, Constipation, Gastrointestinal pain, Neuralgia, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Stomach/ intestine spasms and cramping. More constipation events. Heightened nerve pain and anxiety. · Healthcare visit (other): In person doctor visit and testing.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-21
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 2 — Left Voicemail
2021-10-29
Dose 3 — Moderna
2021-10-29
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Dyschezia — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Difficulty with bowel evacuation

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Pruritus — Feeling: Good · Muscle or body aches

Free text: Itching

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-11-06
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches

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

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Survey response — day 28, dose 3
MedDRA: Flank pain, Pruritus, Self-medication, Urticaria — Feeling: Good · 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: Hives like pain and itching on both sides of my torso of unknown origin, but could be a good allergy. Managing it with Histomine blockers, low sugar and antihistamine foods. OTC antihistamines cause no improvement.

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Report sent to call center — day 28, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-30
Call 2 — Could Not Reach Participant
2021-12-03
Survey response — day 35, dose 3
MedDRA: Dental prosthesis user, Office visit, Oral surgery, Surgery, Tooth fracture — 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

Free text: Symptoms: Oral surgery for broken teeth and implants · Healthcare visit (other): Surgery in Dental Surgeon office

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Report sent to call center — day 35, 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

1 call case(s)
2021-12-03
Call 3 — Could Not Reach Participant
2021-12-10
Survey response — day 42, dose 3
MedDRA: Dental implantation, Office visit, Oral surgery, Tooth extraction, Tooth fracture — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Oral surgery to remove broken teeth and add implants · Healthcare visit (other): Visit to Dental surgeon

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-13
Call 2 — Could Not Reach Participant
2021-12-16
Call 3 — Could Not Reach Participant
2022-01-30
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-11
Dose 4 — Moderna
2022-04-19
Survey response — day 7, dose 4
MedDRA: Injection site rash, Pruritus — Feeling: Good · Site: Itching

Free text: Itching occurred for 4 days after vaccination. Then diminished. Rash the size of a baseball at injection site for 2 days. Has since gone away.

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Survey response — day 14, dose 4
MedDRA: Body temperature increased, Fatigue, Pain, SARS-CoV-2 test negative, Sinus congestion, Somnolence — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fatigue, Fever 99.4F, Body Aches, sinus congestion. Went away in 36 hrs. Took Covid Rapid Test-Negative. Slept most of the time.

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Survey response — day 28, dose 4
MedDRA: Constipation, Fatigue, Infrequent bowel movements, Insomnia, Medical counselling, Myalgia, Office visit, Sleep disorder — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Constipation, infrequency of bowel movement, muscle pain in back and left him, waking up in the middle of the night and unable to go back to sleep and mid day fatigue · Healthcare visit (other): Dr office visit and email

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Report sent to call center — day 28, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-16
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-28
Survey response — day 42, dose 4
MedDRA: Myalgia, Tendonitis — Feeling: Good · Be unable to do your normal daily activities

Free text: Tendinitis and muscle pain

MedDRA releases: 2024-11 · check-in free text available
2022-07-13
Survey response — 3 months, dose 4
MedDRA: Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Dental implants and digestive issue

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Survey response — 6 months, dose 4
MedDRA: Constipation, Office visit, Pain — Feeling: Fair · 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: Out constipation issue . Painful evacuation. A little worse than ever before. Managing it with doctors.

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-31
Dose 5 — Moderna
2023-01-01
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Redness · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2023-01-02
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2023-01-03
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Itching · Muscle or body aches

Adult check-in
2023-01-04
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Muscle or body aches

Adult check-in
2023-01-05
Survey response — days 1–6 daily, dose 5
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-01-06
Survey response — days 1–6 daily, dose 5
MedDRA: Bowel movement irregularity, Fatigue, Reaction to previous exposure to any vaccine — Feeling: Fair · Site: Itching

MedDRA releases: 2024-11
2023-01-07
Survey response — day 7, dose 5
MedDRA: Gastrointestinal disorder — Feeling: Good

MedDRA releases: 2024-11
2023-01-15
Survey response — day 14, dose 5
MedDRA: Adverse reaction, Bronchospasm, Cough, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-01-15
Report sent to call center — day 14, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2023-01-16
Call 1 — Requested Callback
2023-01-16
Callback requested for
04:00PM ET
2023-01-16
Call successful
Does not wish to fill out VAERS report
2023-01-21
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2023-01-28
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2023-02-11
Survey response — day 42, dose 5
MedDRA: Gastrointestinal disorder — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-03
Survey response — 3 months, dose 5
MedDRA: Arthralgia, Burning sensation, Musculoskeletal pain, Office visit, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-03
Report sent to call center — 3 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-04
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-23	Moderna
2	2021-02-20	Moderna
3	2021-10-29	Moderna	No
4	2022-04-11	Moderna	No
5	2022-12-31	Moderna	No

Call center

11 call center cases

11 successful

4 waits over 3 months for a first call

See the call center timeline

Free text

Release 3 — day 14, dose 1

2021-02-06

Symptoms: Swollen gums on upper left side of teeth not related to vaccine.

Release 4 — days 1–6 daily, dose 2

2021-02-25

Systemic reaction (other): Stomach cramps with low back pain on and off since I got the shot.

Release 5 — day 14, dose 2

2021-03-06

Symptoms: Chronic bowel evacuation issue has gotten worse. Not sure if there is a relationship between the vaccine and this condition.

Release 5 — day 21, dose 2

2021-03-13

Symptoms: Nausea and stomach cramps, prolly tied to my gastritis

Healthcare visit (other): Personal visit with my doctor

Release 6 — day 28, dose 2

2021-03-20

Symptoms: Esophagus inflamation and nausea.

Release 6 — day 42, dose 2

2021-04-03

Symptoms: Fatigue, pain in lower back similar to pain experienced after my shots, pain in left piraformis

Release 8 — 3 months, dose 2

2021-05-24

Symptoms: Lower back pain that impacts my ability to move my bowels. Similar pain that I got after my vaccine.

Healthcare visit (other): Metabolic testing, physical therapy, virtual consultation with Dr.

Release 9 — 6 months, dose 2

2021-08-21

Symptoms: Stomach/ intestine spasms and cramping. More constipation events. Heightened nerve pain and anxiety.

Healthcare visit (other): In person doctor visit and testing.

Release 10 — days 1–6 daily, dose 3

2021-10-31

Systemic reaction (other): Difficulty with bowel evacuation

2021-11-03

Systemic reaction (other): Itching

Release 10 — day 28, dose 3

2021-11-26

Symptoms: Hives like pain and itching on both sides of my torso of unknown origin, but could be a good allergy. Managing it with Histomine blockers, low sugar and antihistamine foods. OTC antihistamines cause no improvement.

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Oral surgery for broken teeth and implants

Healthcare visit (other): Surgery in Dental Surgeon office

Release 10 — day 42, dose 3

2021-12-10

Symptoms: Oral surgery to remove broken teeth and add implants

Healthcare visit (other): Visit to Dental surgeon

Release 11 — day 7, dose 4

2022-04-19

Systemic reaction (other): Itching occurred for 4 days after vaccination. Then diminished. Rash the size of a baseball at injection site for 2 days. Has since gone away.

Release 11 — day 14, dose 4

2022-04-25

Symptoms: Fatigue, Fever 99.4F, Body Aches, sinus congestion. Went away in 36 hrs. Took Covid Rapid Test-Negative. Slept most of the time.

Release 11 — day 28, dose 4

2022-05-09

Symptoms: Constipation, infrequency of bowel movement, muscle pain in back and left him, waking up in the middle of the night and unable to go back to sleep and mid day fatigue

Healthcare visit (other): Dr office visit and email

Release 11 — day 42, dose 4

2022-05-28

Symptoms: Tendinitis and muscle pain

Release 12 — 3 months, dose 4

2022-07-13

Symptoms: Dental implants and digestive issue

Release 12 — 6 months, dose 4

2022-10-12

Symptoms: Out constipation issue . Painful evacuation. A little worse than ever before. Managing it with doctors.

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	Medical counselling	·	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Surgery	·	·	✓
HCVO	Telemedicine	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Anxiety	✓	·	✓
SD	Arthralgia	·	·	✓
SD	Back pain	✓	✓	✓
SD	Body temperature increased	·	·	✓
SD	Bowel movement irregularity	✓	✓	✓
SD	Bronchospasm	·	·	✓
SD	Burning sensation	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Constipation	✓	·	✓
SD	Cough	·	·	✓
SD	Dental implantation	·	·	✓
SD	Dental prosthesis user	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Flank pain	·	·	✓
SD	Gastritis	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Gastrointestinal pain	✓	·	✓
SD	Gingival swelling	✓	✓	✓
SD	Infrequent bowel movements	·	·	✓
SD	Insomnia	·	·	✓
SD	Musculoskeletal pain	·	·	✓
SD	Myalgia	·	·	✓
SD	Nausea	✓	✓	✓
SD	Neuralgia	✓	·	✓
SD	Oesophagitis	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oral surgery	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Piriformis syndrome	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	·	·	✓
SD	Reaction to previous exposure to any vaccine	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Self-medication	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sleep disorder	·	·	✓
SD	Somnolence	·	·	✓
SD	Tendonitis	·	·	✓
SD	Tooth extraction	·	·	✓
SD	Tooth fracture	·	·	✓
SD	Urticaria	·	·	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Bowel movement irregularity	·	·	✓
SRO	Condition aggravated	·	·	✓
SRO	Dyschezia	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Gastrointestinal disorder	·	·	✓
SRO	Injection site rash	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pruritus	·	·	✓
SRO	Reaction to previous exposure to any vaccine	·	·	✓

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