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2AJ-26906-91820

3 vaccinations 7 coded responses 38 check-ins 6 free-text entries 5 call cases
Sex
Female
Age at first dose
61-65
ZIP prefix
549 / WI
Registered
2021-03-15
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-15
    Registered in v-safe
  2. 2021-03-15
    Dose 1 — Moderna
  3. 2021-03-15
    Survey response — day 0, dose 1
    MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Free text: I do have OA and Fibromyalgia- maybe these make me more vulnerable
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-03-16
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  5. 2021-03-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness
    Adult check-in
  6. 2021-03-18
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  7. 2021-03-19
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Headache
    Adult check-in
  8. 2021-03-20
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  9. 2021-03-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  10. 2021-03-22
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-03-29
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-04-05
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-04-12
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  14. 2021-04-19
    Health check-in — day 35, dose 1
    Feeling: Good
    Adult check-in
  15. 2021-04-23
    Dose 2 — Moderna
  16. 2021-04-26
    Survey response — days 1–6 daily, dose 2
    MedDRA: Joint swelling, Pre-existing disease, Unevaluable event — Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, 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: Systemic reaction (other): About 8 hours after receiving Moderna #2, my left knee started swelling and I had to use a cane to ambulate. I had a total knee replacement on the left about 12 years ago. · Healthcare visit (other): Had left knee X-ray, D-Dimer, left LE ultrasound and Chest CT angio. All were normal except D-Dimer was greater than 1400.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-04-26
    Report sent to call center — days 1–6 daily, dose 2
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2021-04-27
    Survey response — days 1–6 daily, dose 2
    MedDRA: Arthralgia, Dysstasia — Feeling: Fair · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Free text: Left knee still quite painful (7/10). Very stiff, difficult to get up from sitting position. But overall, maybe a tiny bit better.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-04-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  20. 2021-04-29
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  21. 2021-04-30
    Survey response — day 7, dose 2
    MedDRA: Arthralgia, Lumbar spinal stenosis, Office visit, Pain in extremity — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Systemic reaction (other): Saw Orthopedic MD today, knee/leg pain thought to be related to lumbar stenosis · Healthcare visit (other): Orthopedic surgeon agreed that my SX are not likely related to my second Moderna vaccine a week ago
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  22. 2021-04-30
    Report sent to call center — day 7, dose 2
    Be unable to work · Get care from a doctor or other healthcare professional
    1 call case(s)
  23. 2021-05-07
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-05-14
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-21
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-05-31
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-06-04
    Survey response — day 42, dose 2
    MedDRA: Arthralgia, Back pain — Feeling: Fair · Be unable to work, 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: Right Shoulder pain and decreased ROM.Worsening back pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  28. 2021-06-04
    Report sent to call center — day 42, dose 2
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  29. 2021-07-23
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  30. 2021-10-22
    Survey response — 6 months, dose 2
    MedDRA: Office visit, Rotator cuff repair, Rotator cuff syndrome, Surgery — 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
    Free text: Symptoms: Right Rotator Cuff tear with surgery. · Healthcare visit (other): Outpatient surgery
    MedDRA releases: 2024-11 · check-in free text available
  31. 2021-10-22
    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
    1 call case(s)
  32. 2021-10-25
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  33. 2022-01-04
    Dose 3 — Moderna
  34. 2022-01-06
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  35. 2022-01-07
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness
    Adult check-in
  36. 2022-01-08
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · Headache, Muscle or body aches
    Adult check-in
  37. 2022-01-09
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · Fatigue or tiredness
    Adult check-in
  38. 2022-01-10
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Headache, Fatigue or tiredness
    Adult check-in
  39. 2022-01-13
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  40. 2022-01-18
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  41. 2022-01-25
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  42. 2022-02-01
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  43. 2022-02-08
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  44. 2022-02-15
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  45. 2022-04-05
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  46. 2022-07-05
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  47. 2023-01-04
    Survey response — 12 months, dose 3
    MedDRA: Chills, Pain, Pyrexia — 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
    MedDRA releases: 2024-11
  48. 2023-01-04
    Report sent to call center — 12 months, 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)
  49. 2023-01-05
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-03-15Moderna
22021-04-23Moderna
32022-01-04Moderna No

Call center

5 call center cases

5 successful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-15

Systemic reaction (other): I do have OA and Fibromyalgia- maybe these make me more vulnerable

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): About 8 hours after receiving Moderna #2, my left knee started swelling and I had to use a cane to ambulate. I had a total knee replacement on the left about 12 years ago.
Healthcare visit (other): Had left knee X-ray, D-Dimer, left LE ultrasound and Chest CT angio. All were normal except D-Dimer was greater than 1400.

2021-04-27

Systemic reaction (other): Left knee still quite painful (7/10). Very stiff, difficult to get up from sitting position. But overall, maybe a tiny bit better.

Release 8 — day 7, dose 2

2021-04-30

Systemic reaction (other): Saw Orthopedic MD today, knee/leg pain thought to be related to lumbar stenosis
Healthcare visit (other): Orthopedic surgeon agreed that my SX are not likely related to my second Moderna vaccine a week ago

Release 8 — day 42, dose 2

2021-06-04

Symptoms: Right Shoulder pain and decreased ROM.Worsening back pain.

Release 10 — 6 months, dose 2

2021-10-22

Symptoms: Right Rotator Cuff tear with surgery.
Healthcare visit (other): Outpatient surgery

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

FieldPreferred term2021-092023-042024-11
HCVOOffice visit ✓ ✓ ✓
HCVOSurgery · · ✓
HCVOUnevaluable event ✓ ✓ ✓
SDArthralgia ✓ ✓ ✓
SDBack pain ✓ ✓ ✓
SDChills · · ✓
SDPain · · ✓
SDPyrexia · · ✓
SDRotator cuff repair · · ✓
SDRotator cuff syndrome · · ✓
SROArthralgia ✓ ✓ ✓
SRODysstasia ✓ ✓ ✓
SROJoint swelling ✓ ✓ ✓
SROLumbar spinal stenosis ✓ ✓ ✓
SROOffice visit ✓ ✓ ✓
SROPain in extremity ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

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

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