28G-29440-95721

3 vaccinations 6 coded responses 36 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 484 / MI
Registered: 2021-03-12

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

2021-03-12
Registered in v-safe
2021-03-12
Dose 1 — Moderna
2021-03-12
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Headache

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Headache

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-28
Survey response — day 14, dose 1
MedDRA: Fatigue, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Lymphadenopathy, Medical counselling, Pain, Respiratory tract congestion — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Redness, swelling, heat, itching at Injection site. More fatigue, aching and congestion with swollen glands in neck. · Healthcare visit (other): Consult with pharmacist and local health department nurse

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Survey response — day 21, dose 1
MedDRA: Immunisation reaction — Feeling: Good

Free text: Covid arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Dose 2 — Moderna
2021-04-09
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-04-12
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Mild dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Rash, not including the immediate area around the injection site

Adult check-in
2021-04-16
Health check-in — day 7, dose 2
Feeling: Fair · Site: Redness · None

Adult check-in
2021-04-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-30
Survey response — day 21, dose 2
MedDRA: Arthralgia, Joint range of motion decreased, Lymphadenopathy — Feeling: Good · Be unable to do your normal daily activities

Free text: Swollen lymph nodes arm pit area of arm receiving vaccine. Pain in shoulder to neck area. Limited range of motion on that side.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-09
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-08
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-15
Dose 3 — Moderna
2021-12-19
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-22
Health check-in — day 7, dose 3
Feeling: Good · Site: Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-31
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-05
Survey response — day 21, dose 3
MedDRA: Urticaria — Feeling: Poor · 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: Sporadic hives and possibly Vaculitis

MedDRA releases: 2024-11 · check-in free text available
2022-01-05
Report sent to call center — day 21, 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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-06
Call 1 — Left Voicemail
2022-01-06
Call successful
Does not wish to fill out VAERS report
2022-01-12
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-01-19
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-01-26
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-16
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-06-15
Survey response — 6 months, dose 3
MedDRA: Condition aggravated, Pre-existing disease, Unevaluable event — 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, Emergency room or emergency department visit, Hospitalization

Free text: 2 weeks after Moderna booster, I had a relapse of Vaculitis in January 2022. In April of 2022 I suffered a drug induced liver injury from a medication I was taking as a prophylactic while on steroids for the Vasculitis.

MedDRA releases: 2024-11 · check-in free text available
2022-06-15
Report sent to call center — 6 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 · Hospitalization · 1 call case(s)
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 2 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-12-15
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-04-09	Moderna
3	2021-12-15	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 6 — day 14, dose 1

2021-03-28

Symptoms: Redness, swelling, heat, itching at Injection site. More fatigue, aching and congestion with swollen glands in neck.

Healthcare visit (other): Consult with pharmacist and local health department nurse

Release 6 — day 21, dose 1

2021-04-03

Symptoms: Covid arm

Release 7 — days 1–6 daily, dose 2

2021-04-12

Systemic reaction (other): Mild dizziness

Release 8 — day 21, dose 2

2021-04-30

Symptoms: Swollen lymph nodes arm pit area of arm receiving vaccine. Pain in shoulder to neck area. Limited range of motion on that side.

Release 10 — day 21, dose 3

2022-01-05

Symptoms: Sporadic hives and possibly Vaculitis

Release 12 — 6 months, dose 3

2022-06-15

Symptoms: 2 weeks after Moderna booster, I had a relapse of Vaculitis in January 2022. In April of 2022 I suffered a drug induced liver injury from a medication I was taking as a prophylactic while on steroids for the Vasculitis.

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	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Joint range of motion decreased	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Unevaluable event	·	·	✓
SD	Urticaria	·	·	✓
SRO	Dizziness	✓	✓	✓

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