2JV-17340-19466

4 vaccinations 8 coded responses 37 check-ins 8 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 275 / NC
Registered: 2021-01-25

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

2021-01-25
Registered in v-safe
2021-01-25
Dose 1 — Moderna
2021-01-25
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-01
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-15
Survey response — day 21, dose 1
MedDRA: Dyspnoea — Feeling: Good

Free text: I feel short of breath today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Dose 2 — Moderna
2021-02-22
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Good

Free text: Felt like I couldnt get enough air today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 28, dose 2
MedDRA: Bronchitis, Laryngitis, Oropharyngeal pain, Productive cough, Pulmonary congestion, Respiratory disorder, Sinusitis — 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

Free text: Respiratory problems. Phlegmy lungs. Laryngitis, sore throat, Probable bronchitis. Followed by sinus infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — day 28, 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)
2021-03-29
Survey response — day 35, dose 2
MedDRA: Abdominal pain upper — Feeling: Good

Free text: Sharp pain upper right quadrant of torso.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — day 42, dose 2
MedDRA: Axillary mass, Costochondritis, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Costachondritis and an enlarged lump (lymph node?) in armpit · Healthcare visit (other): Have another appt 4/7

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-06-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-23
Survey response — 6 months, dose 2
MedDRA: Asthenia, Chest discomfort, Heart rate irregular, Office visit — Feeling: Good · 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: Symptoms: Some heart beat blips, reduced stamina, chest discomfort · Healthcare visit (other): Saw my doc, now working with cardiologist

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Call successful
Participant prefers to complete VAERS report online
2021-11-04
Dose 3 — Moderna
2022-02-22
Survey response — 12 months, dose 2
MedDRA: Arthritis infective, Ophthalmic migraine — Feeling: Good · 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: Ocular migraine, knee infection

MedDRA releases: 2024-11 · check-in free text available
2022-02-22
Report sent to call center — 12 months, dose 2
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 · 1 call case(s)
2022-02-23
Call successful
Does not wish to fill out VAERS report
2022-04-26
Dose 4 — Moderna
2022-04-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

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

Adult check-in
2022-04-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-03
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-10
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-31
Survey response — day 35, dose 4
MedDRA: Headache, Throat irritation — Feeling: Fair

Free text: Slight scratchy throat and headache.

MedDRA releases: 2024-11 · check-in free text available
2022-06-07
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-26
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-25
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-28
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-22	Moderna
3	2021-11-04	Moderna	No
4	2022-04-26	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 4 — day 21, dose 1

2021-02-15

Symptoms: I feel short of breath today

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): Felt like I couldnt get enough air today

Release 6 — day 28, dose 2

2021-03-22

Symptoms: Respiratory problems. Phlegmy lungs. Laryngitis, sore throat, Probable bronchitis. Followed by sinus infection

Release 6 — day 35, dose 2

2021-03-29

Symptoms: Sharp pain upper right quadrant of torso.

Release 6 — day 42, dose 2

2021-04-05

Symptoms: Costachondritis and an enlarged lump (lymph node?) in armpit

Healthcare visit (other): Have another appt 4/7

Release 9 — 6 months, dose 2

2021-08-23

Symptoms: Some heart beat blips, reduced stamina, chest discomfort

Healthcare visit (other): Saw my doc, now working with cardiologist

Release 11 — 12 months, dose 2

2022-02-22

Symptoms: Ocular migraine, knee infection

Release 11 — day 35, dose 4

2022-05-31

Symptoms: Slight scratchy throat and headache.

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	✓	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Arthritis infective	·	·	✓
SD	Asthenia	✓	·	✓
SD	Axillary mass	✓	✓	✓
SD	Bronchitis	✓	✓	✓
SD	Chest discomfort	✓	·	✓
SD	Costochondritis	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Headache	·	·	✓
SD	Heart rate irregular	✓	·	✓
SD	Laryngitis	✓	✓	✓
SD	Ophthalmic migraine	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Productive cough	✓	✓	✓
SD	Pulmonary congestion	✓	✓	✓
SD	Respiratory disorder	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SD	Throat irritation	·	·	✓
SRO	Dyspnoea	✓	✓	✓

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