2XV-21883-26180

2 vaccinations 8 coded responses 25 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 300 / GA
Registered: 2021-12-21

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-12-21
Registered in v-safe
2021-12-21
Dose 1 — Moderna
2021-12-21
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Nausea, Abdominal pain

Adult check-in
2021-12-22
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-22
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-23
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · 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

Adult check-in
2021-12-23
Report sent to call center — days 1–6 daily, dose 1
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 · 1 call case(s)
2021-12-24
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-25
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-28
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2022-01-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2022-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2022-01-18
Dose 2 — Moderna
2022-01-18
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Nausea

Free text: Dizzy ness

MedDRA releases: 2024-11 · check-in free text available
2022-01-20
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-01-21
Survey response — days 1–6 daily, dose 2
MedDRA: Abnormal dreams, Insomnia — Feeling: Good · Site: Pain

Free text: Insomnia and crazy dreams

MedDRA releases: 2024-11 · check-in free text available
2022-01-22
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea exertional, Vertigo — Feeling: Good · Be unable to do your normal daily activities

Free text: Vertigo symptoms and shortness of breath when exercising since I have gotten the first vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-01-23
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Dizzy and fatigued

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Survey response — days 1–6 daily, dose 2
MedDRA: Hypoaesthesia, Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm that I got vaccinated is feeling sore days later and at times numb

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Survey response — day 7, dose 2
MedDRA: Hypoaesthesia, Paraesthesia — Feeling: Good · Site: Pain · Headache · Be unable to do your normal daily activities

Free text: Arm numbness and tingling

MedDRA releases: 2024-11 · check-in free text available
2022-02-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2022-02-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2022-02-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2022-02-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2022-03-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-04-19
Survey response — 3 months, dose 2
MedDRA: Flank pain, Hysterectomy, Ovarian cyst, Pelvic pain — Feeling: Good · Be unable to work or attend school

Free text: I had a hysterectomy kept my ovaries and since I got my first vaccine I have been having side and pelvic pain. I thought it was gastro related and come to find out I have been diagnosed with ovarian cysts

MedDRA releases: 2024-11 · check-in free text available
2022-07-19
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2023-01-20
Survey response — 12 months, dose 2
MedDRA: Palpitations, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-01-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2023-01-23
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-12-21	Moderna	No
2	2022-01-18	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 10 — day 0, dose 2

2022-01-18

Systemic reaction (other): Dizzy ness

Release 10 — days 1–6 daily, dose 2

2022-01-21

Systemic reaction (other): Insomnia and crazy dreams

Release 11 — days 1–6 daily, dose 2

2022-01-22

Systemic reaction (other): Vertigo symptoms and shortness of breath when exercising since I have gotten the first vaccine

2022-01-23

Systemic reaction (other): Dizzy and fatigued

2022-01-24

Systemic reaction (other): Arm that I got vaccinated is feeling sore days later and at times numb

Release 11 — day 7, dose 2

2022-01-25

Systemic reaction (other): Arm numbness and tingling

Release 11 — 3 months, dose 2

2022-04-19

Symptoms: I had a hysterectomy kept my ovaries and since I got my first vaccine I have been having side and pelvic pain. I thought it was gastro related and come to find out I have been diagnosed with ovarian cysts

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	Flank pain	·	·	✓
SD	Hysterectomy	·	·	✓
SD	Ovarian cyst	·	·	✓
SD	Palpitations	·	·	✓
SD	Pelvic pain	·	·	✓
SRO	Abnormal dreams	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dyspnoea exertional	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Insomnia	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Paraesthesia	·	·	✓
SRO	Vertigo	·	·	✓

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