2AJ-16196-86179

5 vaccinations 13 coded responses 27 check-ins 12 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 193 / PA
Registered: 2021-03-03

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

2021-03-03
Registered in v-safe
2021-03-06
Dose 1 — Moderna
2021-04-03
Dose 2 — Moderna
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Oral mucosal blistering — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Blisters in mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — days 1–6 daily, dose 2
MedDRA: Oral mucosal blistering — Feeling: Good

Free text: Still blisters in my mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — days 1–6 daily, dose 2
MedDRA: Blister, Cough, Oral mucosal blistering — Feeling: Good · Headache, Fatigue or tiredness

Free text: Blisters in my mouth and a cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-04-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-24
Survey response — day 21, dose 2
MedDRA: Contusion, Pain in extremity, Rash, Rash pruritic, Tenderness — Feeling: Good

Free text: Arm where I got my vaccine has ached like the upper arm is tender and bruised. Itchy rash on my face cheek.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Survey response — day 28, dose 2
MedDRA: Pain, Pain in extremity, Rash, Rash pruritic — Feeling: Good

Free text: I still have this itching rash on my face and my arm that got the vaccine in still hurts and aches in the upper arm whenever I lift it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Office visit, Renal failure — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Stage 3b kidney failure · Healthcare visit (other): Dr appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-19
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-03
Survey response — 6 months, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Stage 3b kidney failure

MedDRA releases: 2024-11 · check-in free text available
2021-10-03
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-05
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-05
Dose 3 — Moderna
2022-04-03
Survey response — 12 months, dose 2
MedDRA: Anaemia, Gout, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: CKD and anemia, gout

MedDRA releases: 2024-11 · check-in free text available
2022-04-03
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-04-04
Call 1 — Could Not Reach Participant
2022-04-07
Call successful
Participant prefers to complete VAERS report online
2022-04-23
Dose 4 — Moderna
2022-04-24
Survey response — days 1–6 daily, dose 4
MedDRA: Pain in extremity — Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain in my arm

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-04-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-04-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-02
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-07
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-14
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-21
Survey response — day 28, dose 4
MedDRA: Blood creatine increased, Blood urea increased, Glomerular filtration rate decreased — Feeling: Poor

Free text: My eGFR went from 41 to 25. My BUN has gone up also my creatinine went up.

MedDRA releases: 2024-11 · check-in free text available
2022-05-29
Survey response — day 35, dose 4
MedDRA: Fatigue — Feeling: Fair

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-06-04
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-23
Survey response — 3 months, dose 4
MedDRA: Cough, Fatigue, Nasal congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stuffy nose cough fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-10-25
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-11-04
Dose 5 — Moderna
2023-04-23
Survey response — 12 months, dose 4
MedDRA: Myalgia — Feeling: Good

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Moderna
2	2021-04-03	Moderna
3	2021-11-05	Moderna	No
4	2022-04-23	Moderna	No
5	2022-11-04	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Blisters in mouth

2021-04-08

Systemic reaction (other): Still blisters in my mouth

2021-04-09

Systemic reaction (other): Blisters in my mouth and a cough

Release 7 — day 21, dose 2

2021-04-24

Symptoms: Arm where I got my vaccine has ached like the upper arm is tender and bruised. Itchy rash on my face cheek.

Release 8 — day 28, dose 2

2021-05-01

Symptoms: I still have this itching rash on my face and my arm that got the vaccine in still hurts and aches in the upper arm whenever I lift it.

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Stage 3b kidney failure

Healthcare visit (other): Dr appointment

Release 9 — 6 months, dose 2

2021-10-03

Symptoms: Stage 3b kidney failure

Release 11 — 12 months, dose 2

2022-04-03

Symptoms: CKD and anemia, gout

Release 11 — days 1–6 daily, dose 4

2022-04-24

Systemic reaction (other): Pain in my arm

Release 11 — day 28, dose 4

2022-05-21

Symptoms: My eGFR went from 41 to 25. My BUN has gone up also my creatinine went up.

Release 11 — day 35, dose 4

2022-05-29

Symptoms: Fatigue

Release 12 — 3 months, dose 4

2022-07-23

Symptoms: Stuffy nose cough fatigue

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	Anaemia	·	·	✓
SD	Blood creatine increased	·	·	✓
SD	Blood urea increased	·	·	✓
SD	Contusion	✓	✓	✓
SD	Cough	·	·	✓
SD	Fatigue	·	·	✓
SD	Glomerular filtration rate decreased	·	·	✓
SD	Gout	·	·	✓
SD	Myalgia	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Renal failure	✓	✓	✓
SD	Tenderness	✓	✓	✓
SRO	Blister	○	✓	○
SRO	Cough	✓	✓	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Pain in extremity	·	·	✓

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