2JM-11458-57325

4 vaccinations 13 coded responses 25 check-ins 12 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 954 / CA
Registered: 2021-02-14

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

2021-01-26
Dose 1 — Moderna
2021-02-14
Registered in v-safe
2021-02-14
Survey response — day 14, dose 1
MedDRA: Arthralgia, Chest pain, Dizziness — Feeling: Fair

Free text: Dizziness. Upper arm shoulder pain. Left chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — day 21, dose 1
MedDRA: Chest pain, Dizziness, Emergency care — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Dizziness, chest pain, currently in Emergency Department

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-23
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-03-01
Dose 2 — Moderna
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain — Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Free text: Pain at back of neck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Limb discomfort — Feeling: Good · Site: Pain, Itching

Free text: Sore arm, that's it

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Good

Free text: Left arm pain from 1st moderna vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Good

Free text: Arm still sore from 1st shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — day 7, dose 2
MedDRA: Limb discomfort — Feeling: Good

Free text: Arm discomfort from 1st shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 21, dose 2
MedDRA: Dizziness, Emergency care, Hypertension, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Elevated BP 130s, sometimes 140s/high 80s some of the time. Most likely more related to being cooped up and not vaccine, but thought i should mention as this is new for me. Discovered when dizzy and sought care. · Healthcare visit (other): Urgent care with my PCP who sent me to ER but it was after 1st shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Call successful
Participant prefers to complete VAERS report online
2021-08-30
Survey response — 6 months, dose 2
MedDRA: Fluid retention, Peripheral swelling, Pre-existing disease — Feeling: Good

Free text: Both of my legs are swollen (water retention) most of the time. I had minor problems with swollen legs off and on since age 30 but now they seem swollen almost all the time. Sonce April 2021. Had a fairly normal annual cardiologist work up in April.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-04
Dose 3 — Moderna
2022-03-02
Survey response — 12 months, dose 2
MedDRA: Dry mouth, Visual impairment — Feeling: Good

Free text: Dry mouth and vision issues

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Dose 4 — Pfizer-BioNTech
2022-04-24
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-12
Survey response — 3 months, dose 4
MedDRA: Back pain, Sciatica — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Structural back pain severe sciatica left side

MedDRA releases: 2024-11 · check-in free text available
2022-07-12
Report sent to call center — 3 months, dose 4
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 · 1 call case(s)
2022-07-13
Call 1 — Left Voicemail
2022-07-13
Call 1 — Left Voicemail
2022-07-13
Call 1 — Left Voicemail
2022-07-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-11
Survey response — 6 months, dose 4
MedDRA: COVID-19, Cough, Larynx irritation, Pyrexia, SARS-CoV-2 test negative — 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 · Telehealth, virtual health, or email health consultation

Free text: Got Covid 9/5/2022 did not test negative until 9/18/22. Fever 101.3 x 2 days. Today 10/11/22 still have larynx irritation and cough.

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Report sent to call center — 6 months, dose 4
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 · 1 call case(s)
2022-10-12
Call 1 — Could Not Reach Participant
2022-10-13
Call successful
Participant prefers to complete VAERS report online
2023-04-12
Survey response — 12 months, dose 4
MedDRA: Musculoskeletal stiffness — 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
2023-04-12
Report sent to call center — 12 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)
2023-04-13
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-03-01	Moderna
3	2021-11-04	Moderna	No
4	2022-04-12	Pfizer-BioNTech	No

Call center

5 call center cases

4 successful · 1 unsuccessful

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 14, dose 1

2021-02-14

Symptoms: Dizziness. Upper arm shoulder pain. Left chest pain

Release 4 — day 21, dose 1

2021-02-16

Symptoms: Dizziness, chest pain, currently in Emergency Department

Release 4 — days 1–6 daily, dose 2

2021-03-02

Systemic reaction (other): Pain at back of neck

2021-03-03

Systemic reaction (other): Sore arm, that's it

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Left arm pain from 1st moderna vaccine

2021-03-07

Systemic reaction (other): Arm still sore from 1st shot

Release 5 — day 7, dose 2

2021-03-08

Systemic reaction (other): Arm discomfort from 1st shot

Release 6 — day 21, dose 2

2021-03-22

Symptoms: Elevated BP 130s, sometimes 140s/high 80s some of the time. Most likely more related to being cooped up and not vaccine, but thought i should mention as this is new for me. Discovered when dizzy and sought care.

Healthcare visit (other): Urgent care with my PCP who sent me to ER but it was after 1st shot

Release 9 — 6 months, dose 2

2021-08-30

Symptoms: Both of my legs are swollen (water retention) most of the time. I had minor problems with swollen legs off and on since age 30 but now they seem swollen almost all the time. Sonce April 2021. Had a fairly normal annual cardiologist work up in April. cut off by CDC

Release 11 — 12 months, dose 2

2022-03-02

Symptoms: Dry mouth and vision issues

Release 12 — 3 months, dose 4

2022-07-12

Symptoms: Structural back pain severe sciatica left side

Release 12 — 6 months, dose 4

2022-10-11

Symptoms: Got Covid 9/5/2022 did not test negative until 9/18/22. Fever 101.3 x 2 days. Today 10/11/22 still have larynx irritation and cough.

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	Emergency care	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dry mouth	·	·	✓
SD	Emergency care	✓	✓	✓
SD	Fluid retention	✓	·	✓
SD	Hypertension	✓	✓	✓
SD	Larynx irritation	·	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Peripheral swelling	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sciatica	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Limb discomfort	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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