38E-12429-82661

2 vaccinations 15 coded responses 19 check-ins 15 free-text entries 7 call cases

Sex: Female
Age at first dose: 21-25
ZIP prefix: 618 / IL
Registered: 2021-01-16

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

2021-01-04
Dose 1 — Moderna
2021-01-16
Registered in v-safe
2021-01-16
Survey response — day 7, dose 1
MedDRA: Limb mass — Feeling: Fair · Site: Itching · Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site

Free text: Lump in crease of my left elbow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-01-25
Survey response — day 21, dose 1
MedDRA: Abdominal pain upper, Back pain, Limb mass, Neck pain, Neuralgia, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: Severe lower back pain and neck pain. Nerve pain throughout my body. Stomach cramping. Still have a lump in my left elbow and pain that comes and goes in my left arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — day 28, dose 1
MedDRA: Back pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Severe lower back pain. It seems to go away but then just gets worse.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Dose 2 — Moderna
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Severe lower back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Poor · Site: Pain, Itching · Chills, Headache, Joint pains, Muscle or body aches, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Severe lower back pain!!!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Office visit — Feeling: Fair · Site: Pain, Itching · Chills, Headache, Joint pains, Muscle or body aches, Diarrhea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Severe lower back pain · Healthcare visit (other): I work at a chiropractic clinic so I had the doctor give me an adjustment and tell me what to do to help the pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Lower back pain!!!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Office visit — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Lower back pain · Healthcare visit (other): Care from the chiropractic clinic I work at

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-11
Survey response — day 7, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Lower back pain!!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — day 14, dose 2
MedDRA: Back pain, Chills, Pyrexia, Rash erythematous — Feeling: Fair · Be unable to do your normal daily activities

Free text: Persistent lower back pain, red rashes, feeling feverish/having a fever & having chills

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — day 21, dose 2
MedDRA: Asthenia, Back pain, Myalgia, Office visit, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Very constant ringing in both ears. Back pain/muscle pain and weakness. · Healthcare visit (other): Care from the chiropractic office I work at

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Survey response — day 28, dose 2
MedDRA: Back pain, Elbow deformity, Limb mass, Office visit, Tinnitus — Feeling: Fair · 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: Symptoms: Ears ringing constantly, lump in left elbow crease still present, lower back pain still. · Healthcare visit (other): Met with my primary care physician and got a referral to another specialist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Survey response — day 35, dose 2
MedDRA: Back pain, Specialist consultation, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Ears ringing almost constantly and very loudly. Lower back pain. · Healthcare visit (other): Visit with primary care doctor. And referral to ENT/audiologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-18
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Survey response — 3 months, dose 2
MedDRA: Back pain, Tinnitus — 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

Free text: Ears ringing and lower back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
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)
2021-07-19
Call 1 — Left Voicemail
2021-08-05
Survey response — 6 months, dose 2
MedDRA: Abdominal distension, Back pain, Gastrointestinal disorder, Office visit, Tinnitus — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: GI issues, bloating, etc. still ringing in my ears all the time. Lower back pain. · Healthcare visit (other): Chiropractic office

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-05
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-15
Call 1 — Could Not Reach Participant
2021-08-19
Call 2 — Could Not Reach Participant
2021-12-11
Call successful
Participant prefers to complete VAERS report online
2022-02-04
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-04	Moderna

Call center

7 call center cases

7 successful

See the call center timeline

Free text

Release 2 — day 7, dose 1

2021-01-16

Systemic reaction (other): Lump in crease of my left elbow

Release 2 — day 21, dose 1

2021-01-25

Symptoms: Severe lower back pain and neck pain. Nerve pain throughout my body. Stomach cramping. Still have a lump in my left elbow and pain that comes and goes in my left arm.

Release 3 — day 28, dose 1

2021-02-01

Symptoms: Severe lower back pain. It seems to go away but then just gets worse.

Release 3 — days 1–6 daily, dose 2

2021-02-06

Systemic reaction (other): Severe lower back pain

2021-02-07

Systemic reaction (other): Severe lower back pain!!!!

2021-02-08

Systemic reaction (other): Severe lower back pain

Healthcare visit (other): I work at a chiropractic clinic so I had the doctor give me an adjustment and tell me what to do to help the pain

2021-02-09

Systemic reaction (other): Lower back pain!!!!

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Lower back pain

Healthcare visit (other): Care from the chiropractic clinic I work at

Release 4 — day 7, dose 2

2021-02-11

Systemic reaction (other): Lower back pain!!!

Release 4 — day 14, dose 2

2021-02-18

Symptoms: Persistent lower back pain, red rashes, feeling feverish/having a fever & having chills

Release 4 — day 21, dose 2

2021-02-25

Symptoms: Very constant ringing in both ears. Back pain/muscle pain and weakness.

Healthcare visit (other): Care from the chiropractic office I work at

Release 5 — day 28, dose 2

2021-03-04

Symptoms: Ears ringing constantly, lump in left elbow crease still present, lower back pain still.

Healthcare visit (other): Met with my primary care physician and got a referral to another specialist

Release 5 — day 35, dose 2

2021-03-11

Symptoms: Ears ringing almost constantly and very loudly. Lower back pain.

Healthcare visit (other): Visit with primary care doctor. And referral to ENT/audiologist.

Release 8 — 3 months, dose 2

2021-05-06

Symptoms: Ears ringing and lower back pain

Release 9 — 6 months, dose 2

2021-08-05

Symptoms: GI issues, bloating, etc. still ringing in my ears all the time. Lower back pain.

Healthcare visit (other): Chiropractic office

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	Specialist consultation	✓	✓	✓
SD	Abdominal distension	✓	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Elbow deformity	○	✓	○
SD	Gastrointestinal disorder	✓	·	✓
SD	Limb mass	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Neuralgia	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Limb mass	✓	✓	✓

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