2GY-13924-60720

4 vaccinations 6 coded responses 21 check-ins 5 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 641 / MO
Registered: 2021-03-14

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

2021-03-11
Dose 1 — Moderna
2021-03-14
Registered in v-safe
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease, Wheezing — Feeling: Good

Free text: Wheezing from COPD

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 7, dose 1
MedDRA: Condition aggravated, Emergency care, Pre-existing disease — Feeling: Poor · Fever · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: COPD exacerbation Ambulance to hospital hospital

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 7, dose 1
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)
2021-03-25
Survey response — day 14, dose 1
MedDRA: Cardiac failure, Chronic obstructive pulmonary disease, Dyspnoea, Emergency care, Fatigue, Fluid retention — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Shortness of breath, extreme fatigue.Admitted through the ER and the diagnosis was heart failure due to fluid retention in ankles,abdomen, snd lungs.Exacerbated COPD attack Taken by ambulance to the ER

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-08
Dose 2 — Moderna
2021-04-08
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Nausea

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

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I contributed a lot of my symptoms to my overall general health in the first surveys I didnt think it related to the shot so I didnt put it down. Also I did suffer pain at the injection site A lot of pain and I realize that I did not answer that question correctly on the surveys

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 · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-15
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-04-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-08
Survey response — 3 months, dose 2
MedDRA: Fall, Gait disturbance, Pain, Skeletal injury, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I fell backwards and hit a close bone at the top of my thigh bone, left leg. I find it extremely difficult to walk because of the pain. · Healthcare visit (other): Virtual visit with pain management clinic set up for tomorrow Friday, July 9, 2021

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-22
Call 1 — Left Voicemail
2021-10-07
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-24
Dose 3 — Moderna
2021-12-03
Call successful
Does not wish to fill out VAERS report
2022-04-08
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-07-26
Dose 4 — Other-Unknown
2022-10-25
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-01-24
Survey response — 6 months, dose 4
MedDRA: Spinal laminectomy — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

MedDRA releases: 2024-11
2023-01-24
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

Hospitalization · 1 call case(s)
2023-01-25
Call 1 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-11	Moderna
2	2021-04-08	Moderna
3	2021-11-24	Moderna	No
4	2022-07-26	Other-Unknown	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Wheezing from COPD

Release 6 — day 7, dose 1

2021-03-20

Systemic reaction (other): COPD exacerbation Ambulance to hospital hospital

Release 6 — day 14, dose 1

2021-03-25

Symptoms: Shortness of breath, extreme fatigue.Admitted through the ER and the diagnosis was heart failure due to fluid retention in ankles,abdomen, snd lungs.Exacerbated COPD attack Taken by ambulance to the ER

Release 7 — days 1–6 daily, dose 2

2021-04-11

Systemic reaction (other): I contributed a lot of my symptoms to my overall general health in the first surveys I didnt think it related to the shot so I didnt put it down. Also I did suffer pain at the injection site A lot of pain and I realize that I did not answer that question correctly on the surveys

Release 9 — 3 months, dose 2

2021-07-08

Symptoms: I fell backwards and hit a close bone at the top of my thigh bone, left leg. I find it extremely difficult to walk because of the pain.

Healthcare visit (other): Virtual visit with pain management clinic set up for tomorrow Friday, July 9, 2021

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	Unevaluable event	✓	✓	✓
SD	Cardiac failure	✓	✓	✓
SD	Chronic obstructive pulmonary disease	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Fall	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Fluid retention	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Skeletal injury	✓	✓	✓
SD	Spinal laminectomy	·	·	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Wheezing	✓	✓	✓

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